A 45-year-old man underwent truncal vagotomy and pyloroplasty for a perforated duodenal ulcer 10 years ago. He now presents with post-prandial bilious vomiting, abdominal fullness, and weight loss. Endoscopy shows food residue in the stomach. The MOST likely diagnosis is:

• A Roux-en-Y syndrome causing bile reflux into the stomach
• B Dumping syndrome causing rapid gastric emptying
• C Gastroparesis due to vagal denervation impairing gastric motility ✓
• D Recurrent peptic ulcer disease causing pyloric stenosis

Explanation

Truncal vagotomy divides both vagal trunks, which not only reduces acid secretion but also impairs gastric motility (the stomach is vagally innervated for peristalsis). This results in post-vagotomy gastroparesis in 5–10% of patients, characterised by delayed gastric emptying, food retention, bloating, and vomiting. Pyloroplasty is performed alongside vagotomy to compensate for the gastric outlet obstruction that would otherwise result, but it does not fully prevent motility issues. Dumping syndrome presents with early post-prandial diarrhoea/flush from rapid emptying — the opposite scenario. Roux syndrome affects those who have had Roux-en-Y reconstruction.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.