Introduction

Dumping syndrome is a postprandial disorder that occurs after gastric or esophageal surgery due to rapid delivery of nutrients into the small intestine [1]. It is typically classified into early and late forms. Early dumping occurs within 30 minutes of eating and is mediated by osmotic fluid shifts and vasoactive peptide release, whereas late dumping is characterized by postprandial hyperinsulinemic hypoglycemia [1,2].

Roux-en-Y gastric bypass (RYGB) significantly alters gastrointestinal anatomy and physiology, predisposing patients to dumping syndrome [3,4]. The procedure involves the creation of a small gastric pouch that restricts intake and regulates nutrient flow into the jejunum [3].

Although dumping syndrome after RYGB is well described, the functional consequences of markedly altered anatomy following revisional bariatric surgery remain incompletely characterized [5]. Weight regain after RYGB is also a recognized long-term complication and may prompt further intervention [6].

We present a case of severe dumping-type symptoms in a patient with endoscopic findings consistent with a non-discernible gastric pouch following RYGB. Initiation of tirzepatide was associated with marked improvement of symptoms and BMI.