위저추벽성형술(Nissen Fundoplication) 시행 후 발생한 덤핑(Dumping)증후군 1례
A Case of Dumping Syndrome Following Nissen Fundoplication in an Infant
문진수, 양혜란, 배선환, 김재영, 고재성, 서정기,
소속 상세정보
문진수 ( Moon Jin-Soo )
서울대학교 의과대학 소아과학교실
양혜란 ( Yang Hye-Ran )
서울대학교 의과대학 소아과학교실
배선환 ( Bae Sun-Hwan )
서울대학교 의과대학 소아과학교실
김재영 ( Kim Jae-Young )
서울대학교 의과대학 소아과학교실
고재성 ( Ko Jae-Sung )
서울대학교 의과대학 소아과학교실
서정기 ( Seo Jeong-Kee )
서울대학교 의과대학 소아과학교실
KMID : 0816120010040010092
Abstract
덤핑증후군은 소아에서 위식도역류의 치료로 위저추벽성형술을 시행하는 경우에 잘 발생하는 질환으로 당 부하 검사를 통하여 식사 직후에 나타나는 고혈당과 뒤이어 나타나는 저혈당을 보임으로써 진단될 수 있으며, 생 옥수수 전분을 포함한 식이 요법으로
효과적으로 치료될 수 있다. 저자들은 위저추벽성형술을 시행 받은 뒤에 덤핑증후군이 발생한 1례를 경험하였고, 본 질환이 소아에서 위저추벽성형술과 같은 위 수술 후에 수유장애가 있을 경우 반드시 의심해보아야 할 질환이라고 사료되어 문헌 고찰과 함께 보고하는 바이다.
The dumping syndrome has been a known complication of gastric surgery in adults, but it is recognized as a very rare disease in the pediatric population, especially in Korea. We report a case of dumping syndrome in a 10-month-old infant, who underwent Nissen fundoplication for the treatment of gastroesophageal reflux(GER). He was admitted because of aspiration pneumonia, and diagnosed as GER by 24-hour ambulatory esophageal pH monitoring test. For the treatment of GER, Nissen fundoplication was performed. After the operation, symptoms occurred within 30 minutes of meals, such as diaphoresis, palpitation, weakness, abdominal fullness, nausea, and diarrhea. The gastric emptying scan showed very rapid gastric emptying. His oral glucose tolerance tests revealed early-onset hyperglycema followed by delayed-onset hypoglycemia, which was the characteristic finding of the dumping syndrome. We introduced uncooked cornstarch to resolve symptoms and maintain the serum glucose level. After the feeding of uncooked cornstarch, his symptoms subsided and normal oral glucose test was restored. After the six months of treatment, his weight and height were increased dramatically from below 3 percentiles up to the normal range. The dumping syndrome should be considered when an infant suffers from the feeding difficulties after the gastric surgery like Nissen fundoplication, and the diet therapy including uncooked cornstarch could be applied as an effective measure.
키워드
Dumping syndrome;Nissen fundoplication;Gastroesophageal reflux;Uncooked cornstarch
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