Afferent Loop Syndrome after Roux-en-Y Total Gastrectomy Caused by Volvulus of the Roux-Limb

Abstract

Afferent loop syndrome is a rare complication of gastric surgery. An obstruction of the afferent limb can present in various ways. A 73-year-old man presented with one day of persistent abdominal pain, gradually radiating to the back. He had a history of total gastrectomy with a Roux-en-Y reconstruction. Abdominal computed tomography scan revealed dilation of the duodenum and small intestine in the left upper quadrant. Exploratory laparotomy showed volvulus of the biliopancreatic limb that caused afferent loop syndrome. In this patient, the 50 cm long limb was the cause of volvulus. It is important to fashion a Roux-limb of appropriate length to prevent this complication.

Management of afferent loop syndrome after Roux-en-Y subtotal gastrectomy and choledocolithiasis with recurrent cholangitis

“…Afferent loop syndrome is a rare complication that occurs in 0.2%–1% in patients after gastrectomy with a Billroth II or Roux-en-Y anastomosis 2–4. This condition is generally caused by mechanical occlusion of the afferent or biliopancreatic loop, due to recurrence or metastasis of cancer in malignant settings, adhesions, internal hernia, torsion, kinking at the anastomosis or enterolithiasis.…”

“…It is caused by a partial or total obstruction of the afferent loop of the anastomosis. It is typically a chronic complication that may occur several years after surgery and can be caused by adhesions, kinking and angulation of the small bowel, internal herniation or stenosis of the gastro-jejunal anastomosis 2 3. A similar effect can occur after a Roux-en-Y reconstruction by stenosis or obstruction of the biliopancreatic limb 2–5…”

Biliopancreatic limb obstruction after laparoscopic Roux‐en‐Y gastric bypass: a rare and potentially fatal condition

“…The etiology of the biliopancreatic limb obstruction includes adhesions, volvulus, stricture, and internal hernia at jejunojejunal anastomosis site . Treatment includes emergent exploration either laparoscopically or open.…”

Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience

“…Traditionally, ALS was managed surgically with a repeat anastomosis or bypass [2,3]. More recently, endoscopic management of ALS has emerged and has been associated with low morbidity [2].…”

“…More recently, endoscopic management of ALS has emerged and has been associated with low morbidity [2]. This includes balloon dilation, placement of double pigtail or metal stents across the site of obstruction, or a combi-Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience nation of the two [3]. If patients present with obstructive jaundice or cholangitis, a percutaneous biliary catheter can adequately drain the afferent loop and biliary tract.…”