A 55-year-old man who underwent subtotal gastrectomy 1 year ago develops sweating, palpitations, and dizziness 2 hours after meals. Symptoms improve when he lies down. Early dumping syndrome has been ruled out. What is the underlying mechanism?

• A Rapid fluid shift into the small bowel lumen causing hypovolemia
• B Vagal hyperstimulation causing bradycardia
• C Bile reflux causing mucosal irritation
• D Reactive hypoglycemia due to rapid glucose absorption and exaggerated insulin response ✓

Explanation

Late dumping syndrome occurs 1-3 hours after meals due to rapid carbohydrate absorption causing hyperglycemia, followed by exaggerated insulin release and subsequent reactive hypoglycemia. Early dumping (15-30 minutes) is due to fluid shift and hypovolemia. Management includes dietary modification (low glycemic index, small frequent meals) and octreotide in refractory cases.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.