Introduction: Post-prandial hyperinsulinaemic hypoglycaemia (PPHH) is a recognized complication of various gastric surgeries in children, but rarely reported after oesophageal atresia repair. We report 2 children diagnosed with PPHH after oesophageal surgery and the challenges of their management. Case 1: A 2-year-old boy diagnosed with oesophageal atresia at birth was surgically repaired requiring 6 oesophageal dilatations in the first year of life. At 11 months of age, he manifested hypoglycaemic seizures and investigations confirmed PPHH. Acarbose and diazoxide trials failed. He was managed with 17-h continuous gastrostomy feeds. Currently, he is 28 months old with euglycaemia on daytime bolus gastrostomy feeds and overnight 12-h continuous gastrostomy feeds. Case 2: A 6-month-old girl diagnosed with Wolf-Hirschhorn syndrome and tracheo-oesophageal fistula was surgically repaired, requiring monthly oesophageal dilatations. At 5 months of age, she was reported to have hypoglycaemia and PPHH was confirmed. She responded to diazoxide and continuous nasogastric tube feeds, but developed pulmonary hypertension pos-sibly diazoxide-induced. Subsequently, diazoxide was stopped and normoglycaemia was secured via 20-h continuous gastrostomy feeds. Conclusion: PPHH may be an underdiagnosed complication in children undergoing surgery for oesophageal atresia. These children must be monitored closely for symptoms of hypoglycaemia and if there are concerns must be screened for possible PPHH. Our cases demonstrate that continuous feeding regimens might be the only therapeutic option, until PPHH gradually lessens in intensity over time.

1.
Service
GJ
,
Thompson
GB
,
Service
FJ
,
Andrews
JC
,
Collazo-Clavell
ML
,
Lloyd
RV
.
Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery
.
N Engl J Med
.
2005
Jul
;
353
(
3
):
249
54
.
[PubMed]
0028-4793
2.
Calabria
AC
,
Charles
L
,
Gilver
S
.
De leon DD Postprandial Hypoglycemia in Children after Gastric Surgery
.
Clinical Characterization and Pathophysiology Horm Res Paediatr
.
2016
;
85
:
140
6
.
[PubMed]
3.
Caulfield
ME
,
Wyllie
R
,
Firor
HV
,
Michener
W
.
Dumping syndrome in children
.
J Pediatr
.
1987
Feb
;
110
(
2
):
212
5
.
[PubMed]
0022-3476
4.
Rivkees
SA
,
Crawford
JD
.
Hypoglycemia pathogenesis in children with dumping syndrome
.
Pediatrics
.
1987
Dec
;
80
(
6
):
937
42
.
[PubMed]
0031-4005
5.
Samuk
I
,
Afriat
R
,
Horne
T
,
Bistritzer
T
,
Barr
J
,
Vinograd
I
.
Dumping syndrome following Nissen fundoplication, diagnosis, and treatment
.
J Pediatr Gastroenterol Nutr
.
1996
Oct
;
23
(
3
):
235
40
.
[PubMed]
0277-2116
6.
Michaud
L
,
Sfeir
R
,
Couttenier
F
,
Turck
D
, F Gottrand F: Dumping Syndrome after Esophageal Atresia Repair without Antireflux Surgery Pediatr Surg.
2010
;45(4):E13-E15
7.
Vukovic
R
,
Milenkovic
T
,
Djordjevic
M
,
Mitrovic
K
,
Todorovic
S
,
Sarajlija
A
,
Hussain
K.
Postprandial Hyperinsulinemic Hypoglycemia in a Child as a late Complication of Esophageal Reconstruction. J Pediatr Endocrinol Metab.
2017
; 0139
8.
Montgomery
M
,
Escobar-Billing
R
,
Hellström
PM
,
Karlsson
KA
,
Frenckner
B
.
Impaired gastric emptying in children with repaired esophageal atresia: a controlled study
.
J Pediatr Surg
.
1998
Mar
;
33
(
3
):
476
80
.
[PubMed]
0022-3468
9.
Yagi
M
,
Homma
S
,
Iwafuchi
M
,
Uchiyama
M
,
Matsuda
Y
,
Maruta
T
.
Electrogastrography after operative repair of esophageal atresia
.
Pediatr Surg Int
.
1997
Jul
;
12
(
5-6
):
340
3
.
[PubMed]
0179-0358
10.
Calabria
AC
,
Gallagher
PR
,
Simmons
R
,
Blinman
T
,
De León
DD
.
Postoperative surveillance and detection of postprandial hypoglycemia after fundoplasty in children
.
J Pediatr
.
2011
Oct
;
159
(
4
):
597
601.e1
.
[PubMed]
0022-3476
11.
Anderson
KD
,
Guzzetta
PC
.
Treatment of congenital microgastria and dumping syndrome
.
J Pediatr Surg
.
1983
Dec
;
18
(
6
):
747
50
.
[PubMed]
0022-3468
12.
Güemes
M
,
Melikyan
M
,
Senniappan
S
,
Hussain
H.
:
Pediatr Endocrinol Metab Idiopathic Postprandial Hyperinsulinaemic Hypoglycaemia
.
2016
; DOI
13.
Holschneider
P
,
Dübbers
M
,
Engelskirchen
R
,
Trompelt
J
,
Holschneider
AM
.
Results of the operative treatment of gastroesophageal reflux in childhood with particular focus on patients with esophageal atresia
.
Eur J Pediatr Surg
.
2007
Jun
;
17
(
3
):
163
75
.
[PubMed]
0939-7248
14.
Borgnon
J
,
Tounian
P
,
Auber
F
,
Larroquet
M
,
Boeris Clemen
F
,
Girardet
JP
, et al
Esophageal replacement in children by an isoperistaltic gastric tube: a 12-year experience
.
Pediatr Surg Int
.
2004
Dec
;
20
(
11-12
):
829
33
.
[PubMed]
0179-0358
15.
Borovoy
J
,
Furuta
L
,
Nurko
S
.
Benefit of uncooked cornstarch in the management of children with dumping syndrome fed exclusively by gastrostomy
.
Am J Gastroenterol
.
1998
May
;
93
(
5
):
814
8
.
[PubMed]
0002-9270
16.
Lehnert
H
,
Beyer
J
,
Weber
P
,
Krause
U
,
Schrezenmeir
J
.
Treatment of severe reactive hypoglycemia with a somatostatin analogue (SMS 201-995)
.
Arch Intern Med
.
1990
Nov
;
150
(
11
):
2401
2
.
[PubMed]
0003-9926
17.
Thondam
SK
,
Nair
S
,
Wile
D
,
Gill
GV
.
Diazoxide for the treatment of hypoglycaemic dumping syndrome
.
QJM
.
2013
Sep
;
106
(
9
):
855
8
.
[PubMed]
1460-2725
18.
Khoshoo
V
,
Reifen
RM
,
Gold
BD
,
Sherman
PM
,
Pencharz
PB
.
Nutritional manipulation in the management of dumping syndrome
.
Arch Dis Child
.
1991
Dec
;
66
(
12
):
1447
8
.
[PubMed]
0003-9888
19.
Timlin
MR
,
Black
AB
,
Delaney
HM
,
Matos
RI
,
Percival
CS
.
Development of Pulmonary Hypertension During Treatment with Diazoxide: A Case Series and Literature Review
.
Pediatr Cardiol
.
2017
Aug
;
38
(
6
):
1247
50
.
[PubMed]
0172-0643
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.