ESPE Abstracts

Introduction: Dumping Syndrome (DS) has been recognized as a major complication of Nissen fundoplication in young children. Althougth other causes have been recognized. We describe a children with esophageal atresia who presented with late DS caused by a surgical complication, Dumping and Horner syndrome were diagnosticated after his surgery.

Case description: A male newborn with prenatal diagnosis of right Aortic Arch was born by vaginal delivery, radiological and clinical findings confirm distal esophagical atresia and distal tracheoesophageal fistula (Gross type C, Vogt type 3B); at 2 days of life he underwent correction and primary esophagical anastomosis with closure of fistula. After procedure palpebral ptosis and diaphragmatic paralysis are noted (ipsilateral to surgical incision). Following a week of fasting with no hypoglycemia (parenteral nutrition was iniciated before surgery), he starts oral feeding with progressive tolerance, but with postprandial hypoglycemia associated with diaphoresis, tachycardia, pallor and hypotonia, always 2 h after oral feeding and related with faster administration of feeding bottle, at physical examination his diaphoresis was asymmetrical (left side face), miosis and ipsilateral palpebral ptosis, followed by adbominal distension relieved by abundant diarrhea and emesis. Such episodes continue during the hospitalization, and getting worst until his referal to our unit. Dumping syndrome was suspected and confirmed by a glucose tolerance test, which showed a postprandial 1 h glycemia of 155 mg/dl, and 2 h post-feeding of 58 mg/dl with elevated insulin values related to this value. The boy was treated with frequent and reduced feeding with important improvement of glycemic values and autonomical symptoms, now receiving anti-reflux formula with no hypoglycemic episodes and adequate weight gain.

Discussion: DS must be suspected in neonates with congenital gastrointestinal malformations who underwent surgical manipulations and present postprandial hypoglycemia related to autonomical symptoms, such manipulation can cause alteration of gastric emptying mechanisms, related to its anatomy or its intrinsic innervation. According to the time of hypoglycemia DS can be classified into two types: early and late, the first related to rapid delivery of hyperosmolar nutrients into the bowel and the second one as result of a reactive hypoglycemia induced by incretin response to carbohydrate ingestion. The therapeutic approach includes cornstarch, pectin, octreotide, and dietary modification. Infrequently reported in children, most of the cases of DS are related to Nissen fundoplication, we report a neonate with dumping syndrome after correction of a congenital malformation.