A 55-year-old man develops a Roux-en-Y gastric bypass-related complication presenting as episodic postprandial cramping, diarrhoea, flushing, and palpitations occurring 30 minutes after eating. Blood glucose during an episode is 45 mg/dL. This is best described as:
- A Early dumping syndrome due to rapid gastric emptying
- B Anastomotic stricture causing functional gastric outlet obstruction
- C Late dumping syndrome (hypoglycaemic dumping) due to exaggerated GLP-1 and insulin release ✓
- D Internal hernia at the mesocolic defect with intermittent obstruction
Explanation
Late dumping syndrome occurs 1–3 hours post-meal (occasionally as early as 30 minutes in bypass patients), characterised by symptoms of hypoglycaemia: sweating, dizziness, palpitations, and neuroglycopenia. It is caused by rapid delivery of carbohydrates into the small bowel, triggering exaggerated secretion of GLP-1 and GIP, leading to excessive insulin release and reactive hypoglycaemia. This is distinct from early dumping (5–30 minutes), which involves osmotic fluid shifts and vagal stimulation without hypoglycaemia. The presence of measured hypoglycaemia (45 mg/dL) confirms this as late/hypoglycaemic dumping. Management includes dietary modification (low-GI diet), acarbose, or rarely octreotide.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.