A Case of Hypoglycemia Diagnosed by Neuropsychiatric Symptoms after Distal Gastrectomy and Total Colectomy.

Abstract

Introduction: Hypoglycemia can lead to significant adverse effects, including cognitive impairment, fatigue, convulsions, and even loss of consciousness in severe cases. Recent reviews also associate hypoglycemia with severe outcomes, such as mortality, dementia, and cardiovascular events. In gastrointestinal surgery, postoperative hypoglycemia related to dumping syndrome is well documented after gastric procedures. However, hypoglycemia in patients who have undergone both gastrectomy and total colectomy is rare, and the underlying mechanisms and effective management strategies remain unclear.

Case presentation: The patient, a 46-year-old woman diagnosed with chronic intestinal pseudo-obstruction (CIPO), had a medical history of distal gastrectomy with Billroth-I reconstruction and colostomy. Recently, she underwent total colectomy, after which she began experiencing symptoms of unexplained malaise, depression, and cognitive decline. She received treatment with medication at a neuropsychiatric department to address these symptoms, but they persisted. Strong anxiety and fatigue led her to engage in frequent drug overdose. She then presented to our hospital. Given her history of gastrointestinal surgery, we considered the possibility of nocturnal hypoglycemia and performed continuous glucose monitoring (CGM), which showed marked hypoglycemia. Nutritional therapy to control hypoglycemia effectively improved her condition, resolving drug overdose behavior completely and reducing the dosage of her psychotropic medications by half.

Conclusion: This case highlights the diagnostic utility of CGM and the effectiveness of nutritional management in treating hypoglycemia after total colectomy in addition to gastrectomy and provides new insights into the management of similar postoperative cases.