Dumping Syndrome is a complication of stomach-shortening procedures, commonly used for surgicat management of peptic ulcer disease. It is seen after Vagotomy + Antrectomy (V+A) and Vagotomy + GastroJejunostomy (i.e. V+D where D is for Drainage)
What happens is that the gastric contents get pushed into the Small Intestine faster than usual. So you have a lot of hyperosmolar contents in the Small Intestine and also a huge load of carbohydrate rich material.
There are two types of Dumping Syndrome: Early and Late.
Early Dumping Syndrome is when this hyperosmolar load will cause acute symptoms due to intestinal congestion. A lot of blood is diverted into the mesentric and splanchic vessels and that leads to some abdominal discomfort, headache, dizziness, palpitations (last three due to shock like symptoms), and even diarrhoea.
Late Dumping Syndrome: This is due to reactive hyperglycemia when the large carb load in the Small Intestine leads to hyperinsulinemia; but this further causes hypoglycemia because excess insulin is released
Treatment is Dietary Management. Tell the patient to eat shorter meals, foods rich in protein and fat but less of carbs, and not to drink water while consuming food (so that osmolarity is low).
If these fail, then Octreotide (Somatostatin Analouge) can be given. Acts by Splanchic Vasconstriction, and decreasing intestinal and gastric transit time. It will also inhibit Insulin release. Acarbose will help in decreasing Carbohydrate absorption.
Surgical Management includes:
- Pyloric reconstruction
- Anastomosis of a 10cm intestinal segment between Pylorus and Duodenum
- Roux En Y Gastrojejunostomy
- Conversion of Bilroth II to Bilroth I
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