Management of afferent loop syndrome after Roux-en-Y subtotal gastrectomy and choledocolithiasis with recurrent cholangitis

Azevedo, Fernando; Canhoto, Carolina; Tralhão, José Guilherme; Carvalho, Hélder

doi:10.1136/bcr-2019-232498

Cited by 3 publications

(4 citation statements)

References 8 publications

(22 reference statements)

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“…In chronic afferent loop syndrome, the patient will have prolonged partial small intestine obstruction features. In chronic afferent loop syndrome on long run, the obstruction will cause pancreatitis, cholangitis and overgrowth of microbes in afferent limb of the jejunum leading to sepsis (2)(3)(4)(5). Although patients with chronic afferent loop syndrome will have cholangitis, it is better to rule put other causes like stricture on hepaticojejunal anastomotic site.…”

Section: Discussionmentioning

confidence: 99%

“…It can be acute or chronic based on its duration of occurrence after the Bill Roth II reconstruction. Acute one will present with in early post-operative complete obstruction but chronic afferent loop syndrome can present with partially obstructed small bowel features for weeks, months and even years (2). The causative agents are classi ed as intraluminal, intramural and extrinsic.…”

mentioning

confidence: 99%

“…In chronic afferent loop syndrome, the patient will have prolonged partial small intestine obstruction features. On long run, the obstruction will cause pancreatitis, cholangitis and overgrowth of microbes in afferent limb of the jejunum leading to sepsis (2)(3)(4)(5). To avoid such complication to happen, there should be surgical correction.…”

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confidence: 99%

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Rare chronic afferent loop syndrome causing partial small bowel obstruction after Bill Roth ii gastro jejunostomy: a case report

Daniel,

woldegiorgis

2024

Preprint

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Background: - chronic afferent loop syndrome is one of rare complication after Bill Roth II gastrojejunostomy. Surgical correction is must to avoid complications that come after conservative management. Most common complications of chronic afferent loop syndrome are sepsis, pancreatitis, cholangitis and ischemia of the afferent loop. Case presentation Here we are presenting 18 years old female patient presented with repeated episodes of bilious vomiting, nausea, epigastric discomfort and distension after her 90th post-truncal vagotomy and Bill Roth II gastrojejunostomy for gastric outlet obstruction secondary to peptic ulcer disease stricture. Braun’s corrective anastomosis done and the patient discharged with improvement. Now the patient was on follow up with no compliant. Conclusion Although rare to happen after Bill Roth II gastrojejunostomy reconstruction, it is better to consider chronic afferent loop syndrome irrespective of surgery done time for those who have bilious vomiting. Revision of the bypass surgery is must for chronic afferent loop syndrome to avoid serious complications.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Rare chronic afferent loop syndrome causing partial small bowel obstruction after Bill Roth ii gastro jejunostomy: a case report

Daniel,

woldegiorgis

2024

Preprint

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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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Percutaneous transhepatic cholangiostomy in children

Melekhina,

Sokolov,

Efremenkov

et al. 2023

Russian Journal of Pediatric Surgery

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Introduction. Congenital malformations of the bile ducts, complicated course of cholelithiasis, strictures of biliodigestive anastomoses, tumors of the pancreatobiliary zone can lead to mechanical jaundice. It is not always possible to perform unloading cholecystostomy for the urgent bile derivation, to stent bile ducts with retrograde endoscopy; more so, to perform radical surgery under hyperbilirubinemia is a risky intervention that can cause complications. Then, percutaneous transhepatic cholangiostomy becomes a method of choice. We present our own experience of interventional surgical procedures on the biliary ducts in children with biliary obstruction. Material and methods. 14 patients, aged 6–17 years , who had 47 interventions were included in the study. Results. In all cases, percutaneous transhepatic cholangiostomy was successful and stopped biliary hypertension. Stricture recanalization after balloon dilation was successful in 4 patients with hepaticoejunoanastomosis stenosis. Puncture neoanastomosis of the disconnected posterior-sectorial duct was performed in 2 patients. External drainage of the bile ducts with subsequent radical treatment was performed in 10 patients; the “Rendez-vous” technique - in 1 patient. Conclusion. Interventional surgical procedures on the bile ducts in children is an effective method of treatment in various clinical situations leading to mechanical jaundice. In some cases, it can effectively stop biliary hypertension. And such methods as recanalization of strictures and puncture neoanastomosis can be a final minimally invasive technique for treating disorders of bile outflow.

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Management of afferent loop syndrome after Roux-en-Y subtotal gastrectomy and choledocolithiasis with recurrent cholangitis

Cited by 3 publications

References 8 publications

Rare chronic afferent loop syndrome causing partial small bowel obstruction after Bill Roth ii gastro jejunostomy: a case report

Rare chronic afferent loop syndrome causing partial small bowel obstruction after Bill Roth ii gastro jejunostomy: a case report

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

Percutaneous transhepatic cholangiostomy in children

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