Late Onset Remnant Gastric Cancer with Afferent Loop Syndrome 47 Years after Billroth II Surgery

Remnant gastric cancer is a rare clinical entity. Herein we describe a patient with remnant gastric cancer that presented with afferent loop syndrome 47 years after Billroth II surgery. Symptoms of serious bilious vomiting were an indication to perform early endoscopic diagnosis, followed by complete gastric resection. In particular, patients that have undergone surgery due to benign indications should be examined endoscopically, even a long time after initial surgery.

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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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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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Successful treatment of remnant gastric cancer with afferent loop syndrome managed by percutaneous transhepatic cholangial drainage followed by elective gastrectomy: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01304-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Shu Aoyama ◽

Masaaki Motoori ◽

Yasuhiro Miyazaki ◽

Tomoki Sugimoto ◽

Yujiro Nishizawa ◽

...

Keyword(s):

Gastric Cancer ◽

Emergency Surgery ◽

Radical Surgery ◽

Elective Surgery ◽

Remnant Gastric Cancer ◽

Afferent Loop ◽

Afferent Loop Syndrome ◽

Afferent Loop Obstruction ◽

Anastomosis Site ◽

Billroth Ii Reconstruction

Abstract Background There are only few reported cases of remnant gastric cancer with concomitant afferent loop syndrome. Emergency surgery is the standard treatment strategy for this disease. However, some afferent loop syndrome cases, especially those with complete obstruction, can lead to a septic state, which makes performing emergency surgery risky. We describe a case of remnant gastric cancer with complete afferent loop obstruction, which was successfully managed by radical surgery following percutaneous transhepatic cholangial drainage of the afferent loop. Case presentation A 71-year-old man presented with nausea and abdominal discomfort. When he was 27 years old, he had undergone distal gastrectomy for a benign gastric ulcer, with gastrojejunostomy (Billroth II reconstruction). Abdominal computed tomography revealed thickening of the anastomosis site and significant dilation of the afferent loop. Gastrointestinal fiberscopy revealed advanced remnant gastric cancer at the anastomosis site, and the stoma of the afferent loop was completely obstructed. We diagnosed the patient with remnant gastric cancer with afferent loop syndrome. Percutaneous transhepatic cholangial drainage was performed twice before surgery to decompress the afferent loop. This provided more time for the patient to recover. Radical surgery of total remnant gastrectomy and Roux-en-Y reconstruction were performed electively. There were no severe postoperative complications. The patient died 8 months following the operation owing to peritoneal dissemination recurrence. Conclusion We encountered a case of remnant gastric cancer with afferent loop obstruction, which was successfully managed by radical surgery following decompression of the afferent loop by percutaneous transhepatic cholangial drainage. Percutaneous transhepatic cholangial drainage effectively managed the afferent loop syndrome, resulting in the safe performance of elective surgery.

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A CASE OF REMNANT GASTRIC CANCER WITH AFFERENT LOOP SYNDROME

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.61.382 ◽

2000 ◽

Vol 61 (2) ◽

pp. 382-385 ◽

Cited By ~ 1

Author(s):

Kazutoshi KOTANI ◽

Yoshiki UMEMORI ◽

Yasushi SATOH ◽

Shigeki MAKIHARA

Keyword(s):

Gastric Cancer ◽

Remnant Gastric Cancer ◽

Afferent Loop ◽

Afferent Loop Syndrome

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Self-expanding metal stent procedure for afferent loop syndrome with ascending cholangitis caused by remnant gastric cancer

Medicine ◽

10.1097/md.0000000000013072 ◽

2018 ◽

Vol 97 (50) ◽

pp. e13072

Author(s):

Ra Ri Cha ◽

Su Beom Cho ◽

Wan Soo Kim ◽

Jin Joo Kim ◽

Jae Min Lee ◽

...

Keyword(s):

Gastric Cancer ◽

Remnant Gastric Cancer ◽

Metal Stent ◽

Afferent Loop ◽

Afferent Loop Syndrome ◽

Ascending Cholangitis

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The Effect of the Change in Lymph Flow Following Gastrectomy for Initial Disease on the Prognosis of Remnant Gastric Cancer

10.21203/rs.3.rs-941649/v1 ◽

2021 ◽

Author(s):

Yoshihiko Kakiuchi ◽

Satoru Kikuchi ◽

Shinji Kuroda ◽

Masahiko Nishizaki ◽

Shunsuke Kagawa ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Poor Prognosis ◽

Malignant Disease ◽

Univariate Analysis ◽

Lymph Flow ◽

University Hospital ◽

Gastric Disease ◽

Remnant Gastric Cancer ◽

Initial Surgery

Abstract Background: Remnant gastric cancer (RGC) has been increasing for various reasons such as longer life span, medical progress, and others. It generally has a poor prognosis, and its mechanism of occurrence is unknown. The purpose of this study was to evaluate the clinicopathological features of and clarify the prognostic factors of RGC.Methods: Between January 2002 and January 2017, 39 patients with RGC following distal gastrectomy underwent curative surgical resection at the Okayama University Hospital; their medical records and immunohistochemically stained extracted specimens were used for retrospective analysis. Results: On univariate analysis, initial gastric disease, pathological lymph node metastasis, and pathological stage were the significant factors associated with a poor overall survival (OS) (p=0.0139, 0.0061, and 0.0158, respectively). Multivariate analysis of these 3 factors showed that only initial gastric disease caused by malignant disease was an independent factor associated with a poor prognosis (p=0.0141, odds ratio [OR]:4.151, 95% confidence interval [CI]:1.333-12.93). In addition, the presence of a left gastric artery (LGA), and tumor-infiltrating CD8+ T cell expression were higher in the benign disease group than in the malignant group (p<0.0001 and p=0.0485, respectively).Conclusion: The lymph flow change caused by lymph node dissection for malignant disease in initial surgery might have an effect on the suppression of tumor immunity and the poor prognosis of RGC.

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

BMJ Case Reports ◽

10.1136/bcr-2019-232498 ◽

2020 ◽

Vol 13 (1) ◽

pp. e232498

Author(s):

Fernando Azevedo ◽

Carolina Canhoto ◽

José Guilherme Tralhão ◽

Hélder Carvalho

Keyword(s):

Bile Flow ◽

Rare Complication ◽

Acute Cholangitis ◽

Subtotal Gastrectomy ◽

Bacterial Overgrowth ◽

Billroth Ii ◽

Afferent Loop ◽

Afferent Loop Syndrome ◽

Biliary Stasis ◽

Multiple Episodes

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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