Afferent Loop Syndrome Research Articles

幽門側胃切除Roux-en-Y再建後，Y脚吻合部狭窄により輸入脚症候群をきたした1例

幽門側胃切除Roux-en-Y再建後，Y脚吻合部狭窄により輸入脚症候群をきたした1例

胃全摘後Roux-Y吻合部膜様狭窄により輸入脚症候群をきたした1例

症例は65歳，男性．2010年10月初旬，胃癌に対して胃全摘術・Roux-Y（以下R-Yと略す）再建を施行した．11月下旬，朝食後右上腹部痛が出現し，来院，CTにて輸入脚の拡張を認め，R-Y吻合部狭窄による輸入脚症候群を疑い，再開腹術を施行した．挙上空腸と横行結腸が腹壁と強固に癒着し，蛇行を認めた為に癒着剥離を行い，術中，経口的内視鏡を術者が用手的にR-Y吻合部まで進め，R-Y吻合部膜様狭窄の内視鏡的バルーン拡張術を施行した．術後1年6カ月の現在まで再狭窄は認められていない．

Complications of Bursectomy after Radical Gastrectomy for Gastric Cancer

We were pleased to read the article by Imamura et al. [1] titled with ‘‘Influence of Bursectomy on Operative Morbidity and Mortality after Radical Gastrectomy for Gastric Cancer: Results of a Randomized Controlled Trial’’. In our center, we routinely perform bursectomy for radical gastrectomy for gastric cancers, and we agree that increased surgical experience can decrease the operative morbidity and mortality. However, we have some questions and comments about this article. Although the authors found no difference of overall morbidity between bursectomy and nonbursectomy groups, we believe that the risk of increased specific complications that were representative for bursectomy should be clarified. As the authors mentioned, adhesions to the mesocolon and pancreas may cause specific local symptoms, such as delayed gastric emptying, afferent loop syndrome, or intestinal obstruction. There were five such complications in bursectomy group (4.8%), and three of those patients required relaparotomy (2.8%). There was only one (1%) such complication in the nonbursectomy group and no related relaparotomy. Although the difference of those specific complications were not significant (P = 0.12), they were suggestive. What do the authors think about the effects of bursectomy on these specific complications? In this series, the nonbursectomy group had a significantly greater number of combined organ resections. What were the complication rates of bursectomy and nonbursectomy groups when there were no combined organ resections? Although the authors reported that bursectomy required a longer operating time (median 27 min in patients with combined resection, 26 min in patients without a combined resection) the overall P value in Table 2 was 0.368. Was there any statistical difference or not between the groups for the operating time?

Severe afferent loop syndrome. Correction by transposition of the efferent loop (technic of Henley, Soupault, Bucaille)

Severe afferent loop syndrome. Correction by transposition of the efferent loop (technic of Henley, Soupault, Bucaille)

Results of Braun Entero-Enterostomy for Suspected Afferent Loop Syndrome in Patients Who Had a Whipple for Chronic Pancreatic Pain

Results of Braun Entero-Enterostomy for Suspected Afferent Loop Syndrome in Patients Who Had a Whipple for Chronic Pancreatic Pain

A case of acute pancreatitis due to afferent loop syndrome with internal hernia

Acute pancreatitis and afferent loop syndrome (ALS) have similar symptoms and physical findings. Accurate early diagnosis is essential, as the management of acute pancreatitis is predominantly conservative whereas ALS usually requires surgery. We experienced one case of pancreatitis due to ALS with internal hernia. Laboratory findings of patient showed elevated serum amylase, lipase and WBC count. One day after admission, diagnosis was modified as acute pancreatitis caused by ALS on computed tomography. Patient was managed with surgical treatment and operation finding revealed ALS due to internal hernia. He was recovered well after surgical treatment and discharged without significant sequelae.

Endoscopic Management of Afferent Loop Syndrome after a Pylorus Preserving Pancreatoduodenecotomy Presenting with Obstructive Jaundice and Ascending Cholangitis

Afferent loop syndrome is a rare complication of gastrojejunostomy. Patients usually present with abdominal distention and bilious avomiting. Afferent loop syndrome in patients who have undergone a pylorus preserving pancreaticoduodenectomy can present with ascending cholangitis. This condition is related to a large volume of reflux through the biliary-enteric anastomosis and static materials with bacterial overgrowth in the afferent loop. Patients with afferent loop syndrome after pylorus preserving pancreaticoduodenectomy frequently cannot be confirmed as surgical candidates due to poor medical condition. In that situation, a non-surgical palliation should be considered. Herein, we report two patients with afferent loop syndrome presenting with obstructive jaundice and ascending cholangitis. The patients suffered from the recurrence of pancreatic cancer after pylorus preserving pancreaticoduodenectomy. The diagnosis of afferent loop syndrome was confirmed, and the patients were successfully treated by inserting an endoscopic metal stent using a colonoscopic endoscope.

A Case of Acute Pancreatitis due to Afferent Loop Syndrome with Internal Hernia

Acute pancreatitis and afferent loop syndrome (ALS) have similar symptoms and physical findings. Accurate early diagnosis is essential, as the management of acute pancreatitis is predominantly conservative whereas ALS usually requires surgery. We experienced one case of pancreatitis due to ALS with internal hernia. Laboratory findings of patient showed elevated serum amylase, lipase and WBC count. One day after admission, diagnosis was modified as acute pancreatitis caused by ALS on computed tomography. Patient was managed with surgical treatment and operation finding revealed ALS due to internal hernia. He was recovered well after surgical treatment and discharged without significant sequelae.

Using Multidetector-Row CT for the Diagnosis of Afferent Loop Syndrome Following Gastroenterostomy Reconstruction

PurposeTo assess the clinical manifestations and multidetector-row computed tomography (MDCT) findings of afferent loop syndrome (ALS) and to determine the role of MDCT on treatment decisions.Materials and MethodsFrom January 2004 to December 2008, 1,100 patients had undergone gastroenterostomy reconstruction in our institution. Of these, 22 (2%) patients were diagnosed as ALS after surgery that included Roux-en-Y gastroenterotomy (n=9), Billroth-II gastrojejunostomy (n=7), and Whipple's operation (n=6). Clinical manifestations and MDCT features of these patients were recorded and statistically analyzed. The presumed etiologies of obstruction shown on the MDCT were correlated with clinical information and confirmed by surgery or endoscopic biopsy.ResultsThe most common clinical symptom was acute abdominal pain, presenting in 18 patients (82%). We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS. Malignant causes of ALS, such as local recurrence and carcinomatosis, are the most common etiologies of obstruction. These etiologies and associated complications can be predicted 100% by MDCT.ConclusionOur results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.

ENDOSCOPIC REMOVAL OF AN ENTEROLITH CAUSING AFFERENT LOOP SYNDROME USING ELECTROHYDRAULIC LITHOTRIPSY

Electrohydraulic lithotripsy is a very useful method for fragmenting biliary stones and it can be used for endoscopic removal of difficult biliary stones. Acute afferent loop syndrome induced by enterolith is very rare, and surgical treatment is the usual choice for this condition. We describe a patient with acute afferent loop syndrome, which was induced by an enterolith after a Billroth II gastrectomy. We used electrohydraulic lithotripsy to endoscopically remove the enterolith.

A Case of Afferent Loop Syndrome After Total Gastrectomy

A Case of Afferent Loop Syndrome After Total Gastrectomy

Acute cholangitis due to afferent loop syndrome after a Whipple procedure: a case report

IntroductionPatients with resection of stomach and especially with Billroth II reconstruction (gastro jejunal anastomosis), are more likely to develop afferent loop syndrome which is a rare complication. When the afferent part is obstructed, biliary and pancreatic secretions accumulate and cause the distention of this part. In the case of a complete obstruction (rare), there is a high risk developing necrosis and perforation. This complication has been reported once in the literature.Case presentationA 54-year-old Greek male had undergone a pancreato-duodenectomy (Whipple procedure) one year earlier due to a pancreatic adenocarcinoma. Approximately 10 months after the initial operation, the patient started having episodes of cholangitis (fever, jaundice) and abdominal pain. This condition progressively worsened and the suspicion of local recurrence or stenosis of the biliary-jejunal anastomosis was discussed. A few days before his admission the patient developed signs of septic cholangitis.ConclusionOur case demonstrates a rare complication with serious clinical manifestation of the afferent loop syndrome. This advanced form of afferent loop syndrome led to the development of huge enterobiliary reflux, which had a serious clinical manifestation as cholangitis and systemic sepsis, due to bacterial overgrowth, which usually present in the afferent loop. The diagnosis is difficult and the interventional radiology gives all the details to support the therapeutic decision making. A variety of factors can contribute to its development including adhesions, kinking and angulation of the loop, stenosis of gastro-jejunal anastomosis and internal herniation. In order to decompress the afferent loop dilatation due to adhesions, a lateral-lateral jejunal anastomosis was performed between the afferent loop and a small bowel loop.

A Case of Afferent Loop Syndrome Successfully Treated with Effective Endoscopic Drainage Followed by Elective Surgery

A Case of Afferent Loop Syndrome Successfully Treated with Effective Endoscopic Drainage Followed by Elective Surgery

Metallic Stent Placement in Patients with Recurrent Cancer after Gastrojejunostomy

To assess the technical feasibility and clinical effectiveness of placement of expandable metallic stents in patients with recurrent cancer after a gastrojejunostomy. Data from 39 consecutive patients who had undergone metallic stent placement for recurrent malignant obstruction after a gastrojejunostomy were retrospectively analyzed. Thirty patients underwent a distal gastrectomy with a gastrojejunostomy with (n=10) or without (n=20) jejunojejunostomy, two patients underwent distal gastrectomy with a Roux-en-Y gastrojejunostomy, and seven patients underwent a palliative gastrojejunostomy with (n=5) or without (n=2) jejunojejunostomy. A total of 57 metallic stents were used in this study: four bare stents, 29 partially covered stents, and 24 fully covered stents. Types of obstruction were classified into 12 patterns and types of stent placement were classified into 16 patterns. Stent placement was technically successful in all patients. After stent placement, 35 of the 39 patients (90%) experienced improvement of their symptoms, two showed no change, and the remaining two showed aggravation of symptoms as a result of faulty stent placement. Two patients treated with stent placement only in the afferent loop died of aspiration pneumonia. In one of two patients who underwent stent placement according to pattern 6, afferent loop syndrome occurred 10 days after stent placement and was treated by percutaneous pigtail catheter drainage. Stent migration occurred in four of 24 fully covered stents, but in none of the bare or partially covered stents. Tumor ingrowth occurred in one of four bare stents, tumor overgrowth in one of 29 partially covered stents, and mucosal prolapse in one of 24 fully covered stents; all were treated with a second stent placement. Placement of expandable metallic stents in patients with recurrent cancer after a gastrojejunostomy seems to be feasible and effective, but accurate knowledge of the type of surgical procedure performed and determination of the pattern of tumor recurrence are important for successful stent placement.

Percutaneous Transhepatic Placement of Covered, Self-expandable Nitinol Stent for the Relief of Afferent Loop Syndrome: Report of Two Cases

The author reports successful outcomes after percutaneous transhepatic placement of covered, self-expandable nitinol stents in two patients who had afferent loop syndrome caused by recurrent gastric carcinoma. A 46-year-old woman and a 60-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy (Billroth II) were both admitted with symptoms of afferent loop syndrome. In each patient, enhanced abdominal computed tomography showed marked dilation of the jejunal limb and intrahepatic bile ducts incident to recurrent gastric carcinoma. Percutaneous transhepatic biliary drainage was successfully performed, and a multi-sidehole drainage catheter was placed beyond the papilla of Vater. Successful palliation of the afferent loop obstruction was achieved by placing a covered, self-expandable nitinol stent through the transhepatic biliary drainage route. There were no procedure-related complications, and both patients showed clinical improvement.

胃全摘後Ｒｏｕｘ‐Ｙ脚の器械吻合部の閉塞により輸入脚症候群を来した１例

胃全摘後Ｒｏｕｘ‐Ｙ脚の器械吻合部の閉塞により輸入脚症候群を来した１例

A case of acute afferent loop syndrome treated by endoscopic decompression

A case of acute afferent loop syndrome treated by endoscopic decompression

Percutaneous jejunostomy and stent placement for treatment of malignant Roux-en-Y obstruction: a case report

Nineteen months after a Whipple procedure for pancreatic carcinoma, a 79-year-old woman developed recurrent tumoral strictures of the bile ducts and afferent Roux-en-Y limb with resultant jaundice, cholangitis, and liver abscess. Transhepatic abscess and biliary drainages were performed first. Afferent loop obstruction was too far from biliary anastomosis to be crossed via the transhepatic route. Percutaneous jejunostomy and stenting were performed to relieve the malignant afferent loop syndrome. After initial relief of symptoms, jaundice recurred in relation to peritoneal carcinomatosis progression and was treated with percutaneous jejunostomy drainage until patient's death. Therapeutic options of tumoral occlusion of afferent loops are reviewed.

3036: Variable features of bile duct obstruction after stomach cancer surgery: US-CT correlation

Stomach ca. is most common malignancy in Korea; it accounts about 22.2% in all of malignancies. In many cases, surgical intervention is choice of treatment and curable method. Mild bile duct dilatation is frequently combined in these patients because of vagotomy which done with gastrectomy. But obstructive jaundice is relatively rare manifestation in postoperative patients of stomach cancer. We analyze 50 cases with obstructive jaundice after stomach cancer surgery. Mechanical obstruction of CBD by enlarged lymph nodes around periportal area was the most common cause of secondary bile duct obstruction in stomach ca. In other cases, metastatic mass in the liver, infiltrating metastasis of bile duct and afferent loop syndrome were also seen as other causes of secondary bile duct obstruction. The propose of this exhibition is to know the variable features of secondary bile duct dilatation in post-stomach cancer surgery patients, and to apply these findings in the clinical settings.

Enteroliths developed in a chronically obstructed afferent loop coexisting with gastric remnant carcinoma: Case report and review of the literature

A case of gastric remnant carcinoma coexisting with a chronic afferent loop syndrome harboring multiple enteroliths in a grossly dilated and elongated afferent loop is presented herein. The patient had undergone a Polya type antecolic Billroth II reconstruction for a stenosing duodenal ulcer 40 years previously. A concise review of the relevant literature is also presented.