Gastrointestinal: Afferent loop syndrome
Journal
Journal of Gastroenterology and Hepatology (Australia)
Journal Volume
21
Journal Issue
8
Pages
1346
Date Issued
2006
Author(s)
Herbella F.A.M.
TSUNG-CHUN LEE
Matone J.
Del Grande J.C.
Tsai M.-C.
Abstract
An afferent loop syndrome is a term that is used to describe symptoms caused by obstruction of an afferent loop. The most common setting is a previous partial gastrectomy with a Billroth II or Polya-type anastomosis. Obstruction is usually caused by recurrent gastric cancer or adhesions but a number of rare causes have been reported including stomal stenosis, marginal ulceration, intussusception and afferent loop enteroliths. The symptoms of afferent loop obstruction are non-specific but include abdominal pain, epigastric fullness, nausea, vomiting and episodes of pancreatitis. Back-pressure within the afferent loop can also result in bile duct dilatation and changes in liver function tests, but the development of jaundice is rare. The diagnosis is usually made by the presence of a dilated loop in the upper abdomen on a computed tomography (CT) scan. Under most circumstances, oral contrast is unable to enter the obstructed loop. The images shown below were CT scans in two patients with an afferent loop syndrome caused by recurrent cancer. The scan shown in Figure 1 shows marked dilatation of an afferent loop. The patient was a woman, aged 51 years, who had previously had a subtotal gastrectomy and Roux-en-Y anastomosis for antral adenocarcinoma. After 15 months, she developed upper abdominal pain, nausea and vomiting. At laparotomy, peritoneal carcinomatosis was found and the obstructed loop was bypassed with an enteroenterostomy. In Figure 2, a dilated afferent loop passes between the aorta (large arrow) and the superior mesenteric artery (small arrow). No oral contrast passed into the afferent loop. The patient was a man, aged 78 years, who had previously been treated with a total gastrectomy and Roux-en-Y anastomosis for a proximal gastric adenocarcinoma. After 6 months, he developed anorexia and abdominal pain and blood tests revealed a mild elevation of plasma amylase and lipase. He was subsequently diagnosed with recurrent gastric adenocarcinoma and referred for palliative care.
SDGs
Other Subjects
abdominal pain; adult; afferent loop syndrome; article; cancer recurrence; case report; computer assisted tomography; enterostomy; epigastric fullness; female; gastrectomy; human; intussusception; laparotomy; liver function test; nausea; pancreatitis; priority journal; Roux Y anastomosis; stomach adenocarcinoma; stomach cancer; superior mesenteric artery; surgical technique; symptom; vomiting
Publisher
Blackwell Publishing
Type
journal article