Possible relation between partial small bowel obstruction and severe postprandial reactive hypoglycemia after Roux-en-Y gastric bypass.

• Although dietary treatment ameliorates symptoms in most patients with postbariatric hypoglycemia (PBH), there is a subgroup with severe symptoms that do not respond sufficiently to either diet or drugs. A clinical observation showed that those patients additionally experienced postprandial abdominal discomfort or pain.This report describes patients with severe PBH following laparoscopic Roux-en Y gastric bypass undergoing corrective surgery to alleviate partial small bowel obstruction (kink, adhesions, dysfunctional anastomosis) and the subsequent outcome regarding symptoms of PBH.Sahlgrenska University Hospital, Sweden.Retrospective analysis regarding hypoglycemic symptoms from medical records and a complementary telephone interview.Out of 80 patients treated for severe PBH at our tertiary academic surgical unit over the last 4 years, 38 underwent corrective surgery (adhesiolysis and/or a reconstructed jejuno-jejunostomy). Out of 21 patients using medications to control hypoglycemia before corrective surgery, 19 (90.5%) discontinued the medication, and 5 of 19 (26%) no longer needed to use a blood glucometer or a continuous glucose monitor. Although patients after surgical correction still could experience PBH, symptoms were less frequent and less severe. Postprandial abdominal symptoms decreased, and patients reported improved eating quality. Patient interviews revealed that 8% became entirely free of PBH symptoms after surgery and 71% experienced significant relief.We propose a possible association between severe hypoglycemic symptoms after laparoscopic Roux-en Y gastric bypass and partial small bowel obstruction. Patients with PBH not responding adequately to diet and drug treatment may benefit from assessment and intervention for partial small bowel obstruction.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Näringslära (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Nutrition and Dietetics (hsv//eng)

Keyword

Adult

Aged

Female

Gastric Bypass

adverse effects

Humans

Hypoglycemia

epidemiology

Intestinal Obstruction

epidemiology

Intestine

Small

Male

Middle Aged

Obesity

Morbid

surgery

Postoperative Complications

epidemiology

Reoperation

statistics & numerical data

Retrospective Studies

Young Adult

Adhesions; Case series; Gastric bypass; Hypoglycemia; Ileus; Intestinal obstruction; Observational study; Reoperation

Publication and Content Type

ref (subject category)

art (subject category)