[Seizures following Billroth II gastrectomy].
METHODS
A 64-year old somnolent man was admitted to the emergency department with a reported seizure half an hour earlier. Due to similar episodes the patient had been treated with antiepileptics in the past. The patient s past history revealed a partial gastrectomy (Billroth II) more than ten years ago.


RESULTS
At the time of admission blood glucose was 31 mg/dl. Other routine laboratory analyses and the clinical examination were normal. In addition, a detailed neurological examination and a cranial CT-scan were normal. Due to the hypoglycemia a dumping syndrome was suspected. A three hour oral glucose tolerance test (OGTT) resulted in a late hypoglycemia, establishing the diagnosis of late dumping. After adaptation of the patient's diet no further hypoglycemic episodes occurred.


CONCLUSIONS
Manifestation of a dumping syndrome may occur even years after gastrectomy. Therefore, in patients presenting with hypoglycemia and a history of gut surgery, a dumping syndrome should be suspected. Furthermore, seizures due to hypoglycemia may be the only manifestation of late dumping.
Harder
J
J
Abteilung Innere Medizin I, Medizinische Klinik, Albert-Ludwigs Universität Freiburg. harder@medizin.ukl.uni-freiburg.de
Mikesch
K
K
Mohr
L
L
Blum
H E
HE
D004377:Dumping Syndrome / Q000150:complications* / Q000178:diet therapy / Q000209:etiology; D005763:Gastroenterostomy / Q000009:adverse effects*; D006801:Humans; D007003:Hypoglycemia / Q000150:complications* / Q000178:diet therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000209:etiology*