Afferent Loop Obstruction After Distal Gastrectomy with Roux‐en‐Y Reconstruction

Aoki, Masaru; Saka, Makoto; Morita, Shinji; Fukagawa, Takeo; Katai, Hitoshi

doi:10.1007/s00268-010-0602-5

Cited by 65 publications

(53 citation statements)

References 21 publications

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“…Roux-en-Y anastomosis avoids anastomosis at the crossing site of the afferent and efferent loops and reduces such complications as afferent loop obstruction, so A-loop obstruction is very rarely following Roux-en-Y reconstruction [2]. In the radical resection of gastric carcinoma in this patient, Roux-en-Y anastomosis of radical gastrectomy was performed.…”

Section: Discussionmentioning

confidence: 88%

Treatment of Afferent Loop Obstruction by Percutaneous Trans-Hepatic Biliary and Intestinal Drainage

Yiming¹

2015

J Palliat Care Med

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We presented a rare case of chronic afferent loop obstruction after radical resection of gastric carcinoma. A 44-year-old man was admitted because of "upper abdominal distension and abdominal pain for 3 months, skin and sclera jaundice for 2 weeks". Abdominal CT revealed dilatation of the intrahepatic bile duct and common bile duct, a large, abdominal cystic lesion, as well as left adrenal gland metastasis. MRCP revealed that the cystic lesion was an expansion of loops. Thus, the diagnosis of afferent loop (A-loop) obstruction was made. Subsequently, the patient underwent percutaneous transhepatic cholangial drainage (PTCD). The patient's abdominal pain was significantly reduced, and the jaundice subsided. We should consider the possibility of the occurrence of the left adrenal metastasis and abdominal lymph node metastasis led to a chronic obstruction of A-loop. The chronic obstruction gradually developed into a complete blockage, further causing biliary obstruction and resulting in the occurrence of severe jaundice and abdominal pain. Here we not only reported a case of chronic afferent loop obstruction following radical resection of gastric carcinoma, but also analyzed the characteristic features of CT imaging and treatment. This case report is a good reference to similar gastrointestinal malignancy. Keywords: Percutaneous trans hepatic cholangial drainage; Afferent loop obstruction Case ReportA 44-year-old man presented with 1-month progressive jaundice, as well as 3-month upper abdominal distension and abdominal pain. He had undergone an "extended radical resection for gastric carcinoma (total gastrectomy, Roux-en-Y anastomosis, distal pancreatectomy, and splenectomy and cholecystectomy)" due to gastric cancer three years ago. Physical examination revealed poor vitality, severe jaundice of the skin and sclera, a soft and movable mass in the upper abdomen. Laboratory examinations showed red blood cell (RBC) 3.0 × 10 9 /L, hemoglobin (HB) 76 g/L, total bilirubin (TBIL) 187.7 µmol/L, albumin (ALB) 26.8 g/L, direct bilirubin (DBIL) 161.5 µmol/L, alkaline phosphatase (ALP) 99 IU/L. The results of tumor markers were as follows: carbohydrate antigen 19-9 (CA199) 80.82 ng/ml, carcinoembryonic antigen (CEA) 5.8 ng/ml. Abdominal CT revealed dilatation of the intrahepatic bile duct and common bile duct, a large, abdominal cystic lesion ( Figure 1A), as well as left adrenal gland metastasis ( Figure 1B).The patient was diagnosed at first with malignant obstructive jaundice. However, what is the reason for biliary obstruction? To investigate the site and cause of bile duct obstruction, we performed Magnetic Resonance Cholangiopancreatography (MRCP) examination. MRCP revealed that the cystic lesion was an expansion of small bowel loops ( Figure 1C). Thus, the diagnosis of afferent loop (A-loop) obstruction was made. Subsequently, the patient underwent percutaneous transhepatic cholangial drainage (PTCD). The duodenal-jejunal anastomotic stricture (Figure 2A) was observed. Taken together, an accurate diagnosis for...

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Section: Discussionmentioning

confidence: 88%

Treatment of Afferent Loop Obstruction by Percutaneous Trans-Hepatic Biliary and Intestinal Drainage

Yiming¹

2015

J Palliat Care Med

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“…A retrospective review of 1908 patients following gastrectomy with Roux-en-y reconstruction found that four patients (0.2%) went on to develop ALS, the causes being internal herniation in two, adhesion in one and peritoneal recurrence in the other. The period between initial and emergency operations had a median of 5 months [4].…”

Section: Discussionmentioning

confidence: 99%

“…ALS is a serious condition with an estimated mortality rate of 30-60% and patients require urgent surgical management to relieve the underling cause [4].…”

Section: Discussionmentioning

confidence: 99%

Afferent Loop Syndrome With Associated Perforation 15 Years After Gastrectomy and Roux-en-y Reconstruction

2015

Int Arch Med

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An elderly patient presented to our institution with abdominal pain, nausea and vomiting. She had an extensive surgical background including gastrectomy with Roux-en-y reconstruction undertaken 15 years earlier. A CT abdomen demonstrated a small bowel obstruction proximal to the jejunojejunostomy with features suggestive of afferent loop syndrome (ALS), a rare but known complication following Roux-en-y reconstruction. Initial surgery identified a band adhesion and an associated ischemic small bowel segment, which was resected with primary anastomosis. A further operation was required at post-operative day five due to clinical deterioration. A retroperitoneal collection was identified secondary to perforation of the afferent loop.

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“…[4] Where gastric carcinoma was the indication for the initial operation, [5] tumour recurrence was noted to outweigh other usual causes such as adhesions, anastomotic ulcers, stenoses, internal hernias in surgically created foraminae (including in the mesentery), twisting foci, or intussusceptions. [2,6] …”

Section: Frequency and Causesmentioning

confidence: 99%

Abdominal imaging: Diagnosis

Misser¹

2013

S Afr J Rad

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Afferent Loop Obstruction After Distal Gastrectomy with Roux‐en‐Y Reconstruction

Cited by 65 publications

References 21 publications

Treatment of Afferent Loop Obstruction by Percutaneous Trans-Hepatic Biliary and Intestinal Drainage

Treatment of Afferent Loop Obstruction by Percutaneous Trans-Hepatic Biliary and Intestinal Drainage

Afferent Loop Syndrome With Associated Perforation 15 Years After Gastrectomy and Roux-en-y Reconstruction

Abdominal imaging: Diagnosis

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