Acute afferent loop syndrome in the early postoperative period following pancreaticoduodenectomy

Nageswaran, H.; Belgaumkar, Ajay; Kumar, Rajesh; Riga, A.; Menezes, Neville; Worthington, Tim; Karanjia, ND

doi:10.1308/003588414x14055925061036

Cited by 17 publications

(5 citation statements)

References 13 publications

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“…Two retrospective cohort studies showed that the incidence of ALS in gastric cancer patients undergoing Billroth II and Roux-en-Y reconstruction was 1.01% and 0.2% respectively, and all were caused by adhesion, internal herniation, and peritoneal recurrence[ 1 , 2 ]. As for treatment, traditionally, surgery is the cornerstone of treatment for ALS, which includes converting a Billroth II to a Roux-en-Y[ 8 ], creating a Braun anastomosis between the afferent and efferent loops in a Billroth II[ 9 ], or excising redundant loops and reconstruction[ 10 ]. However, surgery is not suitable for every patient with ALS[ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of afferent loop syndrome using fluoroscopic-guided nasointestinal tube placement: Two case reports

Hu¹,

Ma²,

Zhen-min³

et al. 2020

WJCC

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BACKGROUND Afferent loop syndrome (ALS) is a rare mechanical complication that occurs after reconstruction of the stomach or esophagus to the jejunum, such as Billroth II gastrojejunostomy, Roux-en-Y gastrojejunostomy, or Roux-en-Y esophagoje-junostomy. Traditionally, an operation is the first choice for benign causes. However, for patients in poor physical condition who experience ALS soon after R0 resection, the type of treatment remains controversial. Here, we present an efficient conservative method to treat ALS. CASE SUMMARY Case 1 was a 69-year-old male patient who underwent total gastrectomy with Roux-en-Y jejunojejunostomy. On postoperative day (POD) 10 he developed symptoms of ALS that persisted and increased over 1 wk. Case 2 was a 59-year-old male patient who underwent distal gastrectomy with Billroth II gastrojejunostomy. On postoperative day POD 9 he developed symptoms of ALS that persisted for 2 wk. Both patients underwent fluoroscopic-guided nasointestinal tube placement with maintenance of continuous negative pressure suction. Approximately 20 d after the procedure, both patients had recovered well and were discharged from hospital after removal of the tube. At 3-mo follow-up, there were no signs of ALS in these two patients. CONCLUSION This is the first report of treating postoperative ALS by fluoroscopic-guided nasointestinal tube placement. Our cases demonstrate that this procedure is an effective and safe method to treat ALS that relieves patients’ symptoms and avoids complications caused by other invasive procedures.

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Section: Discussionmentioning

confidence: 99%

Treatment of afferent loop syndrome using fluoroscopic-guided nasointestinal tube placement: Two case reports

Hu¹,

Ma²,

Zhen-min³

et al. 2020

WJCC

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“…The afferent loop refers to the duodenojejunal loop proximal to the gastrojejunal anastomosis. 62 Its obstruction presents with abdominal pain and vomiting. On imaging, it appears as dilated fluid-filled tubular or C-shaped bowel (afferent limb/ loop) in the right upper quadrant or crossing the midline with transition in the region of anastomosis.…”

Section: Delayed Gastric Emptying: Incidence Of Delayed Gas-mentioning

confidence: 99%

The Postoperative Pancreas Imaging

Taher

Mujtaba

Ramani

et al. 2020

Journal of Gastrointestinal and Abdominal Radiology

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Recent advances in the surgical techniques and postoperative intensive care have led to a decrease in the mortality rates after major pancreatic procedures, which now ranges from 1 to 3%. However, the morbidity rates are still high, resulting in longer hospital stays and greater cost. Imaging plays a fundamental role in the postoperative assessment. Specially, multidetector computed tomography scans (MDCT) is the modality of choice in the postoperative settings. Early diagnosis of the postoperative complications and differentiating them from being normal or expected postoperative findings is crucial to offer the best possible care for patients and to decrease the morbidity and mortality associated with surgery. In this article, we will briefly review the normal pancreatic anatomy, discuss the main types of pancreatic surgeries, and illustrate the imaging findings during the early postoperative period and of the main postsurgical complications in both acute and chronic postoperative settings.

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“…Afferent loop syndrome (ALS) is a complication of Billroth II gastrojejunostomy (GJ), Roux-en-Y gastric bypass, and Whipple procedures. 1 , 2 Common causes include malignant infiltration, internal hernias, postsurgical adhesions, or intrinsic/extrinsic compression causing obstruction. 3 Symptoms include abdominal pain, distention, nausea, and vomiting.…”

Section: Introductionmentioning

confidence: 99%

Afferent Loop Syndrome as Second Presentation of Gastric Outlet Obstruction in Patient With Billroth II Anatomy

2023

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Afferent loop syndrome can result from both benign and malignant strictures of the biliary limbs of patients with surgically altered anatomy. Afflicted patients accumulate intestinal and pancreaticobiliary secretions, which leads to bowel distention and pain. We describe the endoscopic management of a 52-year-old woman with a history of Billroth II gastrojejunostomy due to gastric cancer who developed malignant gastric outlet obstruction and subsequently malignant afferent loop syndrome, using lumen-apposing metal stents.

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Acute afferent loop syndrome in the early postoperative period following pancreaticoduodenectomy

Abstract: Acute ALS is a rare but important complication in the immediate postoperative period following PD and causes disruption to adjacent anastomoses, resulting in a bile leak. A prophylactic Braun anastomosis and wide mesocolic window may prevent this complication and subsequent deterioration.

Cited by 17 publications

References 13 publications

Treatment of afferent loop syndrome using fluoroscopic-guided nasointestinal tube placement: Two case reports

Treatment of afferent loop syndrome using fluoroscopic-guided nasointestinal tube placement: Two case reports

The Postoperative Pancreas Imaging

Afferent Loop Syndrome as Second Presentation of Gastric Outlet Obstruction in Patient With Billroth II Anatomy

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