ACUTE AFFERENT LOOP OBSTRUCTION FOLLOWING GASTRECTOMY WITH A REPORT OF TWO CASES

Abstract

Two cases of acute afferent loop obstruction are described. Case 1. A 52-year-old man with duodenal ulcer underwent antecolic Billroh II gastrectomy. On the 14th postoperative day he suffered nausea, vomiting and abdominal pain of sudden onset. Under a diagnosis of acute intestinal obstruction, relaparotomy was performed. This revealed afferent loop obstruction caused by counterclockwise torsion of the gastric remnant. After restoration of the torsion, Braun's anastomosis was added. Postoperative course was uneventful and he was discharged on the 35th postoperative day. Case 2. A 53-year-old male gastric cancer patient underwent antecolic Billorth II gastrectomy. On the 75th postoperative day, he suffered severe abdominal pain and nausea with occasional vomiting of clear contents without bile. He received conservativ etreatment under a diagnosis of acute pancreatitis. Abdominal pain increased, howerer and he underwent laparotomy 8 days after onset. This revealed afferent loop obstruction due to retroanastomotic hernia. Reposition of the hernia and Braun's anastomosis were performed, but the postoperative course was complicated by anastomotic insufficiency and DIC. He underwent relaparotomy for intraperitoneal drainage 8 days after the second operation. The patient required a long period of intravenous hyperalimentatio, but was able to leave hospital unaided on the 107th postoperative day.