CT Diagnosis of Afferent Loop Syndrome

Gayer, Gabriela; Barsuk, Daphna; Hertz, Marjorie; Apter, Sara; Zissin, Rivka

doi:10.1053/crad.2002.0972

Cited by 43 publications

(31 citation statements)

References 8 publications

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“…5 If DSL is diagnosed after subtotal or total gastrectomy, aggressive management should be initiated immediately, including drainage, oral intake restriction, intravenous fluid administration, and antibiotic therapy. 20 Following this, treatment methods should be modified according to the patient's clinical condition. Re-operation should be considered when the following complications develop: diffuse peritonitis, intra-abdominal hemorrhage, or major wound dehiscence.…”

Section: Discussionmentioning

confidence: 99%

“…19 Common causes of ALS are adhesions, recurrent cancer, inflammatory thickening of the anastomosis, kinking at the anastomosis, internal hernia, stoma stenosis, and inflammation surrounding the anastomosis. 20,21 Some cases of ALS progress rapidly and complications such as peritonitis may develop, which can be fatal. Mortality from these complications has been reported to be 30% to 60%.…”

Section: Discussionmentioning

confidence: 99%

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Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

Kim

Lee

Kim

et al. 2016

International Surgery

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The aim of this study was to elucidate the role of percutaneous transhepatic biliary drainage (PTBD) in patients with duodenal stump leakage (DSL) and afference loop syndrome (ALS) postgastrectomy for malignancy or benign ulcer perforation. Percutaneous transhepatic biliary drainage (PTBD) is an interventional radiologic procedure used to promote bile drainage. Duodenal stump leakage (DSL) and afferent loop syndrome (ALS) can be serious complications after gastrectomy. From January 2002 through December 2014, we retrospectively reviewed 19 patients who underwent PTBD secondary to DSL and ALS postgastrectomy. In this study, a PTBD tube was placed in the proximal duodenum near the stump or distal duodenum in order to decompress and drain bile and pancreatic fluids. Nine patients with DSL and 10 patients with ALS underwent PTBD. The mean hospital stay was 34.3 days (range, 12 to 71) in DSL group and 16.4 days (range, 6 to 48) in ALS group after PTBD. A liquid or soft diet was started within 2.6 days (range, 1 to 7) in the ALS group and within 3.4 days (range, 0 to 15) in the DSL group after PTBD. One patient with DSL had PTBD changed, and 2 patients with ALS underwent additional surgical interventions after PTBD. The PTBD procedure, during which the tube was inserted into the duodenum, was well-suited for decompression of the duodenum as well as for drainage of bile and pancreatic fluids. This procedure can be an alternative treatment for cases of DSL and ALS postgastrectomy.Key words: Gastrectomy -PTBD -Duodenal stump leakage -Afferent loop syndrome P ostoperative complications after gastrectomy are difficult for both patients and surgeons. In the past, most of the major complications after gastrectomy required re-operation. The rate of reoperation for these complications ranges from 2.8% to 10%. 1-3 After gastrectomy, duodenal stump leak-

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

Kim

Lee

Kim

et al. 2016

International Surgery

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“…Obstruction of the small bowel downstream from the afferent loop and subsequent dilation of the afferent loop can occur as a result of adhesions, internal herniation, volvulus, intussusception, stenosis from malignancy, inflammation or large stones [3]. A retrospective review of 1908 patients following gastrectomy with Roux-en-y reconstruction found that four patients (0.2%) went on to develop ALS, the causes being internal herniation in two, adhesion in one and peritoneal recurrence in the other.…”

Section: Discussionmentioning

confidence: 99%

Afferent Loop Syndrome With Associated Perforation 15 Years After Gastrectomy and Roux-en-y Reconstruction

2015

Int Arch Med

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An elderly patient presented to our institution with abdominal pain, nausea and vomiting. She had an extensive surgical background including gastrectomy with Roux-en-y reconstruction undertaken 15 years earlier. A CT abdomen demonstrated a small bowel obstruction proximal to the jejunojejunostomy with features suggestive of afferent loop syndrome (ALS), a rare but known complication following Roux-en-y reconstruction. Initial surgery identified a band adhesion and an associated ischemic small bowel segment, which was resected with primary anastomosis. A further operation was required at post-operative day five due to clinical deterioration. A retroperitoneal collection was identified secondary to perforation of the afferent loop.

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“…Enteroliths forming in an afferent limb are more likely to be radiolucent and less likely identifiable on plain radiographs (2). An upper gastrointestinal series can be helpful to the diagnosis because of poor filling or non filling of the afferent jejunal limb (12); but 20% of normal afferent loops are not opacified (15). Ultrasound (US), used as initial diagnostic procedure in patients with acute abdominal symptoms, may demonstrate a enterolith in a large and dilated bowel loop (2,13).…”

Section: Discussionmentioning

confidence: 99%

“…The valvulae conniventes projecting into the lumen are a common feature. Additional findings include complications of afferent loop syndrome such as biliary dilatation, pancreatitis and enteroliths (15). Multidetector-row computed tomography (MDCT) with coronal plane similar to the human anatomy is believed better than conventional CT in diagnosing site, level, and cause of ALS (18).…”

Section: Discussionmentioning

confidence: 99%

Enterolith causing acute afferent loop syndrome after Billroth II gastrectomy: a case report

Cartanese¹,

Campanella²,

Milano³

et al. 2013

G Chir

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CT Diagnosis of Afferent Loop Syndrome

Cited by 43 publications

References 8 publications

Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

Afferent Loop Syndrome With Associated Perforation 15 Years After Gastrectomy and Roux-en-y Reconstruction

Enterolith causing acute afferent loop syndrome after Billroth II gastrectomy: a case report

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