Abstract
BackgroundNissen Fundoplication is a common surgical procedure performed in treating gastroesophageal reflux disease (GERD). Complications include dysphagia, gastric hypersensitivity, abnormal gastric motility, gas bloat syndrome and GERD relapse. Dumping syndrome may occur when a large volume of gastric content is delivered to the duodenum or jejunum, resulting in both gastrointestinal and vasomotor symptoms. Occasionally, dumping syndrome may be a complication in patients that have undergone nissen Fundoplication, especially in adults. The BreathID® continuous online 13C-Octanoicoctanoic acid breath test detects variations of less than 1/100,000 in the 13CO2/12CO2 ratio in exhaled air.Case presentationWe report a case of a 38 year old male who was admitted and diagnosed with dumping syndrome following nissen Fundoplication, who was diagnosed using the BreathID® continuous online 13C-Octanoic acid breath test.ConclusionsEarly performance of a gastric emptying rate breath test in symptomatic patients, following upper GI tract surgery may help in the prediction or diagnosis of nissen Fundoplication complications such as dumping syndrome.
Highlights
Nissen Fundoplication is a common surgical procedure performed in treating gastroesophageal reflux disease (GERD)
Early performance of a gastric emptying rate breath test in symptomatic patients, following upper GI tract surgery may help in the prediction or diagnosis of nissen Fundoplication complications such as dumping syndrome
As in any other types of invasive procedures, gastric fundoplication is associated with complications that include: dysphagia, gastric hypersensitivity, abnormal gastric motility, gas bloat syndrome and relapse of GERD symptoms [5]
Summary
Described by Nissen in l956, gastric fundoplication was designed as a surgical procedure for the treatment of gastroesophageal reflux disease (GERD) [l]. We report the case of a 38-year-old patient who developed early dumping syndrome following nissen fundoplication. One year after the laparoscopic procedure, the patient underwent exploratory laparotomy, seromyotomy of the distal esophagus and a redo floppy nissen fundoplication. Six months after the redo floppy nissen fundoplication the patient developed severe abdominal pain, bloating, borborygmy, faintness, weakness, palpitations, weight loss (BMI = 28.6) and urgency to defecate, which appeared 10-60 minutes after meals. The abdominal pain was not related to the meal size or content He suffered from explosive chronic diarrhea with 3-6 bowel movements per day. The patient was diagnosed to suffer from severe dumping syndrome which was unresponsive to dietary modifications. Medications such as Guar gum and acarbose were not helpful. After a one-year follow-up, he is pain-free and regained his weight, has well-formed bowel movements and is eating a regular diet
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