AFFERENT LOOP OBSTRUCTION AFTER GASTRECTOMY

Abstract

In this paper, seven patients who suffered afferent loop obstruction after gastrectomy are described together with a discussion on 55 similar patients previously reported in Japan. Afferent loop obstruction almost always occurs as a result of an increase in pressure within the afferent loop and duodenum after the afferent loop has become obstructed for some reason following surgery by the Billroth II method. The condition is often complicated by pancreatitis, resulting in hyperamylasemia, and the chance of surgery is often lost because of conservative treatment given on the basis of a diagnosis of pancreatitis. If the pressure in the afferent loop increases, necrosis and perforation wil occur, and this condition is occasionally operated on under a diagnosis of general peritonitis, or the loop may penetrate the retroperitoneum and be overlooked until it induces septic shock. Although the condition frequently occurs in the absence of Braun's anastomosis in anterior anastomosis of the colon as an initial surgical procedure, it also occurs frequently when Braun's anastomosis is not undertaken even in posterior anastomosis of the colon. In the cases in the present study, the condition was caused by entocele in 29, i.e., 46.8%, adhesion in 21.0% and flexion in 16.1%. CT was particularly useful for the diagnosis. This condition is characterized by the duodenum with the dilated anterior surface of the right kidney and the anterior surface of the abdominal aorta. The treatment involves reduction of hernia, separation of adhesion, enterectomy, intestinal anastomosis, etc. The prognosis of the condition with perforation is poor.