INS and Hypoglycemia: Hypoglycemia is a well-known complication following gastric surgery, commonly associated with dumping syndrome,1) where rapid gastric emptying leads to postprandial hypoglycemia due to a surge in insulin release.1,3) However, cases involving severe hypoglycemia after both gastrectomy and additional extensive gastrointestinal surgeries, such as total colectomy, are rare and not well understood, with no previous reports to our knowledge.