ABSTRACT
A 77-year-old man with history of distal gastrectomy with Billroth II reconstruction for peptic ulcer disease performed 55 years ago was admitted to our hospital for diarrhea and abdominal pain. Abdominal computed tomography revealed a dilatation of the afferent loop and the duodenum, and a low density mass located in the body of the pancreas, which invaded the gastro-jejunal anastomosis site as well as the celiac axis and the superior mesenteric artery. Judging from these findings, we diagnosed this case as acute afferent loop obstruction due to an unresectable pancreatic cancer. Endoscopic decompression of the afferent loop was unsuccessful. After a while, the patient complained a severe abdominal pain, and an emergency surgery was performed under the diagnosis of rupture of the afferent loop. At laparotomy, a perforation of the jejunum located at a 15 cm anal side from Ligament of Treitz was found, and Braun's anastomosis was performed using the perforated site. The patient was treated with chemotherapy and survived for 15 months after the operation. Prompt decompression of afferent loop should be performed for preventing a rupture in case of acute obstruction of the afferent loop.
Subject(s)
Afferent Loop Syndrome/etiology , Pancreatic Neoplasms/pathology , Acute Disease , Afferent Loop Syndrome/pathology , Afferent Loop Syndrome/surgery , Aged , Humans , Jejunum/pathology , Male , Neoplasm Invasiveness , Rupture, SpontaneousABSTRACT
Included is a case study of the afferent loop syndrome after subtotal gastric resection for a peptic ulcer. A 60 year old woman was successfully treated by the ligature of the afferent loop with the anastomosis between efferent loop and the duodenum. By means of this modification the following aims were achieved: 1 elimination of the antiperistaltic function of the afferent loop anastomosed "from the left", 2-replacement of resected stomach by means of anastomosis between the efferent loop and the duodenum.
Subject(s)
Afferent Loop Syndrome/surgery , Afferent Loop Syndrome/pathology , Female , Humans , Methods , Middle AgedABSTRACT
A completely necrotic duodenum in a 26-year-old man due to acute afferent loop obstruction was reported. A total duodenectomy with an implantation of the papilla of Vater into the Roux-en-Y jejunal limb was carried out. The Gastrographin meal study was useful in establishing the diagnosis.
Subject(s)
Afferent Loop Syndrome/surgery , Duodenum/surgery , Adult , Afferent Loop Syndrome/pathology , Duodenum/pathology , Humans , Male , NecrosisSubject(s)
Afferent Loop Syndrome/surgery , Acute Disease , Afferent Loop Syndrome/pathology , Gangrene , Humans , Male , Middle AgedABSTRACT
The morphological changes in the liver and pancreas during the first 12 hours in the acute afferent loop syndrome were studied in rats with a Billroth II gastric resection. Two essentially different types of changes were found in the pancreas. One was a coagulative necrosis without an inflammatory reaction, which has been found after instillation of bile, bile salts and the detergent sodium lauryl sulphate into the pancreatic ducts. The other type of pancreatitis was an intense, acute purulent inflammation often with bacteria visible in the histological sections. In the liver, large areas of necrosis were often encountered, sometimes mixed with polymorphonuclear leukocytes and bacteria, in a few cases combined with thrombi in small portal veins. The changes in the pancreas occurred very rapidly; only 4 hours after occlusion of the afferent loop there were signs of pancreatitis in some cases and 12 hours after occlusion there was an acute pancreatitis in all cases.
