Introduction: Post-prandial hyerinsulinaemic hypoglycaemia (PPHH) or dumping is a recognized complication of various gastric surgeries. There are very few paediatric case reports to confirm PPHH post esophageal repair. We here report two cases who presented with dumping syndrome after a variable time period post esophageal atresia repair and response to medications.
Case 1: A 6 month old female diagnosed with Wolf-Hirschhorn syndrome, born at 38+3 weeks by elective C-section with birth weight of 2040 g. Antenatally diagnosed to have tracheo-oesophageal fistula that was corrected surgically on day 2 of life and then subsequently requiring oesophageal dilatations every month. She was reported to have hypoglycaemia in the post-operative period following oesophageal balloon dilation. Subsequent investigations were suggestive of PPHH, initially responding to Diazoxide and continuous feeds.
Case 2: A 2 year old male born at 38/40 with an antenatal diagnosis of long segment oesophageal atresia (without fistula). On day 3 of life, a fashioned gastrostomy was done to facilitate feeding. He went on to require 6 oesophageal dilatations for the strictures in the first year of life (and had normal blood glucose). At the age of 1 year he presented with a hypoglycaemic seizure. Dumping syndrome was confirmed and was initially tried on Acarbose and Diazoxide, both of which were ineffective in his case. He was finally managed with continuous feeds over 17 h and fasting up to 8 h. On his most recent visit he has been stable on bolus feeds (over 1 h) during daytime and overnight continuous feeds and is thriving well.
Conclusion: PPHH following gastric surgeries for gastro oesophageal reflux are quite common but remains to be an under recognized complication following oesophageal atresia repair in paediatric population. These cases also demonstrate that continuous feeds might be only option if unresponsive to medical therapy and PPHH can get milder over time.
Insight into clinical practise: PPHH is not well known in children undergoing surgery for oesophageal atresia repair and hence it is important to screen them regularly.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes