A CASE OF AFFERENT LOOP OBSTRUCTION DUE TO INVASION OF CARCINOMA OF THE TRANSVERSE COLON

Abstract

A case of afferent loop obstruction due to invasion of carcinoma of the transverse colon is reported. A 69-year-old man was admitted to the hospital because of fever, abdominal pain and nausea. There was a previous history of undergoing a Billroth II antecolic gastrectomy for gastric ulcer 25 years before admission. He was diagnosed as having an advanced carcinoma of the transverse colon by a total colonoscopy and Ba-enema study. The temperature rose to 39°C suddenly, and the laboratory studies revealed leukocytosis and an elevation in CRP level. Ultrasonography and computed tomography revealed a large cystic mass adjacent to the pancreas head and a diagnosis of obstruction of the afferent loop was made. Endoscopic drainage of the afferent loop was attempted but failed. Therefore, an emergency operation was performed on the same day and the obstructed afferent loop was drainaged. Thirteen days after the drainage, he underwent a radical operation for the transverse colon carcinoma. However, he died of carcinomatous peritonitis and multiple lung metastasis 2 months after the operation. Afferent loop obstruction is a complication following gastrectomy, though it is rare. The most common causes of obstruction are internal hernia, adhesion, and flexion. According to the literature, only 2 cases of obstruction of afferent loop due to invasion of colonic carcinoma including our case have been reported in Japan.