David Merkle1, Kazim Mohommed1, Danielle R Rioux2, Dilendra Weerasinghe, MD, FACS3. 1Nova Southeastern University, 2Herbert Wertheim College of Medicine, 3Gulf Pointe Surgical Specialists
Bariatric surgery is gaining popularity not only for its weight loss benefits, but also for its metabolic effects. We present a 44-year-old female patient with symptoms of neuroglycopenia, occurring 11-years post Roux-en-Y gastric bypass surgery. During one of her syncopal episodes, her blood sugar was noted to be 21 mg/dL. Continuous glucose monitoring demonstrated post prandial hypoglycemia, averaging 4 episodes per day, with a maximum of 6 episodes in one day. Upon further evaluation, the lab results of the HbA1c, chromogranin A, somatostatin, and urinary sulfonylurea levels were all normal, with the C-peptide level within the upper limit of normal. CT scan of the abdomen and pelvis did not show any obvious masses in the pancreas, and since the chromogranin A level was normal, it lead to the empiric diagnosis of nesidioblastosis by exclusion. We placed the patient initially on medical management which included a carbohydrate restricted diet of 30g per meal, eating 6-8 small meals per day, and taking 50 mg of acarbose three times per day. Overall, symptoms have improved, and she has 1-2 episodes per month, compared with about 4 episodes per day. We will also present the data with regards to other invasive treatment options, which are available when medical treatment options have failed, such as gastric bypass reversal versus distal gastrectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87029
Program Number: P556
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster