Acute obstruction of the afferent loop after gastrectomy

Abstract

Acute obstruction of the afferent loop is an unusual and disastrous complication after gastrectomy. It is most commonly caused by a rare form of internal herniation. Comprehension of the anatomic defects in retroanastomotic herniation involves a detailed knowledge of the boundaries of the apertures created after gastroenteric anastomoses. The pathophysiology is related to the continued secretion of bile, pancreatic juice, and succus entericus into the obstructed loop. The x-ray and clinical evidence of a mass in the left upper quadrant after gastrectomy, when coupled with the absence of afferent loop filling in a patient whose vomitus or gastric aspirate does not contain bile, should be considered diagnostic of acute obstruction of the afferent loop. The roentgenogram presented is believed to be the first appearing in the literature. The modes of prophylaxis and surgical therapy are related to the type of herniation, location of the hernial aperture, the inciting causes, and viability of the incarcerated bowel.