Afferent Loop Syndrome Due to Scarring of a Stomal Ulcer Following a Billroth II Gastrectomy

Afferent loop syndrome is a rare complication after gastrectomy with Billroth II or Roux-en-Y reconstruction, caused by an obstruction in the proximal loop. The biliary stasis and bacterial overgrowth secondary to this obstruction can lead to repeated episodes of acute cholangitis. We present the case of a male patient who had previously undergone gastrectomy with Roux-en-Y reconstruction and later experienced multiple episodes of acute cholangitis secondary to choledocolithiasis. He underwent an open exploration of the bile ducts with choledocolitotomy, but the events of cholangitis persisted. Further investigation permitted to identify a dilation of the biliary loop of the Roux-en-Y anastomosis, suggesting enterobiliary reflux as the cause of recurrent acute cholangitis. Therefore, a bowel enterectomy and new jejunojejunostomy were undertaken, and normal biliary flow was re-established. The surgical treatment is mandatory in benign causes, leading to the resolution of the obstruction and subsequent normalisation of bile flow.

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Afferent loop syndrome secondary to Billroth II gastrojejunostomy obstruction: Multidetector computed tomography findings

Surgery ◽

10.1016/j.surg.2006.02.024 ◽

2007 ◽

Vol 141 (4) ◽

pp. 538-539 ◽

Cited By ~ 3

Author(s):

Sabri Yilmaz ◽

Ensar Yekeler ◽

Cem Dural ◽

Memduh Dursun ◽

Yakup Akyol ◽

...

Keyword(s):

Computed Tomography ◽

Multidetector Computed Tomography ◽

Billroth Ii ◽

Afferent Loop ◽

Afferent Loop Syndrome

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A CASE OF ACUTE AFFERENT LOOP NECROSIS AND PERFORATION FOLLOWING BILLROTH-II GASTRECTOMY

The journal of the Japanese Practical Surgeon Society ◽

10.3919/ringe1963.58.2331 ◽

1997 ◽

Vol 58 (10) ◽

pp. 2331-2337

Author(s):

Makoto HASEGAWA ◽

Yoshitsugu NAGASHIMA ◽

Kunihisa KOZAWA ◽

Nobuaki WADA ◽

Koichi NAGAO

Keyword(s):

Billroth Ii ◽

Afferent Loop ◽

Billroth Ii Gastrectomy

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Afferent loop syndrome CFD simulation after Billroth II gastric resection

2011 10th International Workshop on Biomedical Engineering ◽

10.1109/iwbe.2011.6079032 ◽

2011 ◽

Author(s):

Danko Z. Milasinovic ◽

Aleksandar M. Cvetkovic ◽

Srdan M. Ninkovic ◽

Nenad D. Filipovic ◽

Milos R. Kojic

Keyword(s):

Gastric Resection ◽

Cfd Simulation ◽

Billroth Ii ◽

Afferent Loop ◽

Afferent Loop Syndrome

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Endoscopic Retrograde Cholangiopancreatography Using a Dual-Lumen Endogastroscope for Patients with Billroth II Gastrectomy

Gastroenterology Research and Practice ◽

10.1155/2013/146867 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Wei Yao ◽

Yonghui Huang ◽

Hong Chang ◽

Ke Li ◽

Xuebiao Huang

Keyword(s):

Endoscopic Sphincterotomy ◽

Balloon Dilatation ◽

Endoscopic Retrograde ◽

Billroth Ii ◽

Safety And Efficacy ◽

Afferent Loop ◽

Billroth Ii Gastrectomy ◽

Needle Knife ◽

Selective Cannulation ◽

Endoscopic Papillary Balloon Dilatation

Objective. To evaluate the safety and efficacy of a dual-lumen forward-viewing endoscope for ERCP in patients with prior Billroth II gastrectomy.Methods. The records of 46 patients treated with ERCP by a dual-lumen forward-viewing endoscope after Billroth II gastrectomy from 2007 to 2012 were reviewed.Results. The success rate of selective cannulation was 82.6% (38/46). Of the 38 cases with successful selective cannulation, endoscopic sphincterotomy was achieved in 23 cases by placing the needle knife through the 2nd lumen, while endoscopic papillary balloon dilatation was conducted in the other 15 cases. Of the 8 failed cases of selective cannulation, 6 had failed afferent loop intubation, and 3 of these 6 patients had Braun’s anastomosis. The safety and efficacy of catheter-assisted endoscopic sphincterotomy were increased by placing the needle knife through the 2nd lumen without altering the conventional endoscopic sphincterotomy procedure.Conclusions. A dual-lumen forward-viewing endoscope can be safely and effectively used to perform ERCP in patients with a Billroth II gastrectomy, except for patients with additional Braun’s anastomosis.

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Afferent Loop Syndrome After Subtotal Gastrectomy With Billroth-II Reconstruction: Etiology and Treatment

International Surgery ◽

10.9738/intsurg-d-15-00137.1 ◽

2016 ◽

Vol 101 (3-4) ◽

pp. 194-200 ◽

Cited By ~ 1

Author(s):

Sung-Heun Kim ◽

Jong-Young Oh ◽

Ki-Han Kim ◽

Min-Chan Kim

Keyword(s):

Gastric Cancer ◽

Subtotal Gastrectomy ◽

Primary Treatment ◽

The Body ◽

Mechanical Complication ◽

Billroth Ii ◽

Afferent Loop ◽

Afferent Loop Syndrome ◽

Billroth Ii Reconstruction ◽

Gastric Cancer Patients

The aim of this study was to evaluate the clinical characteristics, treatment, and prognosis of afferent loop syndrome (ALS) following radical subtotal gastrectomy with B-II reconstruction in gastric cancer patients. ALS is an infrequent mechanical complication, which occurs after reconstruction of Billroth-II (B-II) gastrojejunostomy or Roux-en-Y esophagojejunosotomy. From 2002 through 2010, 672 patients who had undergone subtotal gastrectomy with B-II reconstruction for gastric cancer were enrolled. Clinical data, symptom interval, cause, and treatment of 13 ALS patients were reviewed. The body mass index (BMI) of patients who suffered ALS was significantly less than that of patients who did not (P = 0.0244). And, there were significant differences in rates of recurrence (P = 0.0032) and follow-up duration (P = 0.0119) between the two groups. Acute ALS within 1 month occurred in 5 patients (38.5%). Obstructive jaundice or acute pancreatitis occurred in 4 patients (30.1%). The most frequent cause was anastomosis inflammation (6 patients). Only 2 patients required surgery. Most patients with ALS were treated conservatively with or without percutaneous transhepatic biliary drainage (PTBD). Clinical suspicion is of significant importance because ALS is not common and the symptoms are nonspecific. ALS occurs more frequently in low BMI patients than high. PTBD can be considered as a primary treatment option for ALS if rupture of the afferent loop is not present.

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