Blind loop syndrome bls, also known as stagnant loop syndrome, is a state that occurs when the normal bacterial flora of the small intestine proliferates to numbers that cause significant derangement to the normal physiological processes of digestion and absorption. An afferent loop syndrome is a term that is used to describe symptoms caused by obstruction of an afferent loop. Afferent loop syndrome treated by endoscopic ultrasoundguided. Abdominal computed tomography scan revealed dilation of the duodenum and small intestine. Afferent loop syndrome can occur after some types of gastrojejunostomy. This symptomcomplex has been termed the afferentloop syndrome.
Nov 07, 20 afferent or efferent loop syndrome is a purely mechanical problem characterized by the obstruction of gastric emptying at or near the site of a gastrojejunostomy. Eusguided enteroenterostomy for nonoperative management. Afferent loop syndrome after rouxeny total gastrectomy caused. Efferent loop syndrome is a rare post gastectomy syndrome, while afferent loop syndrome is more common. The biliary stasis and bacterial overgrowth secondary to this obstruction can lead to repeated episodes of. Efferent loop syndrome health encyclopedia university of. Afferent loop syndrome als is caused by mechanical obstruction of the afferent loop of a doublebarrel gastrojejunostomy a. To report the computed tomography ct features of afferent loop syndrome which is often clinically unsuspected. Carrying inward to a central organ or section, as nerves that conduct impulses from the periphery of the body to the brain or spinal cord. Pdf the purpose of this article is to assess the technical feasibility and clinical effectiveness of the placement of partially covered. Als may be surgically corrected by deconstructing the billroth ii gastrojejunostomy and restoring gastrointestinal continuity with a rouxeny gastrojejunostomy b.
Afferent loop syndrome definition of afferent loop syndrome. This gives rise to postprandial nausea and vomiting of. This report describes endoscopic ultra sound eusguided gastrojejunostomy for treatment of afferent loop syndrome, using a lumenapposing. Aspiration from the distended proximal limb yields a high bacterial count, with gramnegative organisms predominating and resembling colonic flora in both quantity and quality 5, 6. Most cases of als are caused by obstruction from adhesions, kinking at the anastomosis, internal hernia, stomal stenosis, malignancy, or inflammation surrounding the anastomosis.
Pdf afferent loop syndrome after rouxeny total gastrectomy. The efferentloop syndrome in a narrow sense refers only to obstruction of the efferent jejunal loop after gastric resection or simple gastroenterostomy. Partial or recurrent obstruction of the afferent loop may occur following a billroth ii gastrectomy. A bowel enterectomy was performed, and new jejunojejunostomy of the rouxeny anastomosis was created. Afferent loop syndrome an overview sciencedirect topics. The major cause of syndrome is an intestinal hernia. It is similar to the blindloop syndrome seen with sidetoside intestinal anastomosis 4. Afferent loop syndrome definition, symptoms, causes.
This symptomcomplex has been termed the afferent loop syndrome. Afferent loop is the duodenal stump into which the biliary and the pancreatic secretions are drained. We report about a patient who developed als, one year after a whipple procedure that was performed because of a pancreatic carcinoma. Afferent loop syndrome is a rare complication of gastric surgery. After a surgical procedure, the pancreatic and bile juices get into the afferent loop.
Management of afferent loop syndrome after rouxeny. He had a history of total gastrectomy with a rouxeny reconstruction. Jul 10, 2006 an afferent loop syndrome is a term that is used to describe symptoms caused by obstruction of an afferent loop. In the following decades several authors were able clearly to demonstrate that bile reflux into the stomach causes vomiting. The purpose of this article is to assess the technical feasibility and clinical effectiveness of the placement of partially covered selfexpandable dual stents in patients with afferent loop syndrome. A 61years old man, who had undergone gastric resection 30 years before, was admitted at emergency room with severe abdominal pain. Magnetic resonance cholangiopancreatography for afferent loop. The purpose of this article is to assess the technical feasibility, clinical effectiveness, and optimal route of dual stent placement for afferent loop syndrome. The afferent loop syndromes result from obstruction to the afferent jejunal loop. Afferent loop syndrome radiology reference article. Afferent loop syndrome is an uncommon complication.
Afferent loop syndrome after rouxeny total gastrectomy. Magnetic resonance cholangiopancreatography for afferent. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Technetium99m hida hepatobiliary scanning in evaluation of. Afferent loop obstruction is a purely mechanical complication that. The other type of loop syndrome is afferent loop syndrome. Afferent loop syndrome is a rare occurrence caused by obstruction of the afferent, or biliopancreatic, loop of a gastrojejunostomy reconstruction.
The loop going to the upper stomach is the afferent loop. Afferent limb syndrome is a relatively common adverse event after whipple pancreatoduodenectomy, occurring in approximately % of cases. Afferent loop syndrome is caused by a partial or complete obstruction on the area where the surgery was done or along the jejunal region of the afferent loop. Treatment by means of the placement of dual stents kichang han1 hoyoung song1 jin hyoung kim1. A 73yearold man presented with one day of persistent abdominal pain, gradually radiating to the back. Afferent loop syndrome als is a rare complication of billrothii gastrojejunostomy.
This case report shows the importance of radiological imaging in a patient with a past history of abdominal surgery, for which no records were available. Afferent loop syndrome is a problem that can occur after some kinds of stomach surgery. The syndrome is produced by retention of bile and pancreatic secretions in the afferent loop. The use of lumenapposing metal stents lamss to decompress an obstructed afferent limb has been described in a handful. Eusguided enteroenterostomy for nonoperative management of. Afferent loop syndrome after subtotal gastrectomy with. Acute als results from complete obstruction, usually occurs early after surgery and runs a devastatingly lethal course unless promptly treated by reoperation. Treatment of afferent loop syndrome using digital cholangioscopy through the percutaneous transhepatic biliary drainage route a 75yearold man with peritoneal recurrence ofdistal bile duct cancer after pancreaticoduodenectomy was admitted because of cholangitis. If the pressure builds up, the bile and pancreatic fluid may then empty into the upper stomach. Pdf acute afferent loop obstruction treated by endoscopic. Hypertonic meals or large volumes of orally ingested liquids may worsen the symptoms. Creation of an anastomosis between the stomach and jejunum leaves a segment of small bowel, most commonly consisting of duodenum and proximal jejunum, lying upstream from the gastrojejunostomy. Acute afferent loop syndrome in the early postoperative period. Afferent loop sydrome common after bilroth ii is characterized by post prandial ruq pain, bilious vomiting, anemia, steatorrhea, and pain which resolves suddenly after decompression.
In some cases of blind loop syndrome, overgrowth of pathogenic noncommensal bacteria has also been noted. Etiology and treatment sungheun kim1, jongyoung oh2, kihan kim1, minchan kim1 1department of surgery and 2department of radiology, donga university college of medicine, busan, korea the aimofthisstudy wastoevaluatetheclinical characteristics, treatment. Afferent loop syndrome definition of afferent loop. The clear differentiation between the afferentloop syndrome als and the other postgastrectomy syndromes was made by hoffmann 3. Afferent loop syndrome in a patient having incomplete.
The diagnosis of afferent loop syndrome was considered, and the patient underwent a midline laparotomy, in which a massive dilation of afferent rouxeny loop, secondary to multiple adhesions, was observed. Afferent loop syndrome als is an infrequent mechanical complication that occurs after reconstruction of billrothii bii gastrojejunostomy or rouxeny esophagojejunostomy. The afferent loop syndrome als is a rare complication of a partial distal gastrectomy with billroth ii reconstruction. Introduction the afferent loop syndrome als is a rare complication of a partial distal gastrectomy with billroth ii reconstruction. Afferent loop syndrome is an intermittent partial or complete mechanical obstruction of the afferent limb of a gastrojejunostomy. Surgeons have improved gastric surgery, so both types of loop syndromes are now less common. Afferent loop syndrome als is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. The most common setting is a previous partial gastrectomy with a billroth ii or polya. Afferent loop sydrome common after bilroth ii is characterized by post prandial ruq pain, bilious vomiting, anemia, steatorrhea, and pain which resolve. Afferent loop syndrome health encyclopedia university of. The clear differentiation between the afferent loop syndrome als and the other postgastrectomy syndromes was made by hoffmann 3, who described the clinical picture as follows. Afferent loop syndrome occurs when something traps the flow of these juices in the afferent loop. Dec 28, 2008 afferent loop syndrome is a mechanical bowel obstruction internal hernia, volvulus, stricturing, etc that results in an effective biliary outlet obstruction. Afferent loop syndrome is a mechanical obstruction of the afferent limb that occurs after billroth ii or roux.
Afferent loop syndrome als is a purely mechanical complication that infrequently occurs following the construction of a gastrojejunostomy. In a loop syndrome, part of the small intestine becomes blocked. Afferent loop syndrome after subtotal gastrectomy with billrothii reconstruction. Afferent limb syndrome also called afferent loop syndrome is a complication following billroth ii gastrojejunostomy characterized by acute or chronic intermittent obstruction of the afferent jejunal limb. Afferent loop syndrome is a rare complication following a billroth ii procedure and is seen in 3 cases. Of the two types of loop syndromes, the other type, afferent loop syndrome, is the more common. During the procedure, a surgeon will remove or bypass the lower part of the stomach and attach the remaining upper part of the stomach to a loop of small intestine. In 18 patients, in whom an afferent loop syndrome was clinically suspected, hepatobiliary scanning demonstrated an altered afferent loop emptying in 8 and atonic distension of the gallbladder without afferent loop motility changes in 10. The probable cause of the syndrome was predicted on the basis of sonography in two of three patients with cancer at the anastomosis. Afferent impulse definition of afferent impulse by. What causes efferent loop syndrome after gastric surgery.
Causes include jejunal herniation, intussusception, kinking, volvulus, marginal ulceration, paraanastomotic. Using multidetectorrow ct for the diagnosis of afferent loop syndrome following gastroenterostomy reconstruction yonsei medical journal, vol. Acute afferent loop syndrome in the early postoperative. In a postop whipple patient, an acute afferent limb obstruction is especially concerning because theres a fresh bilary anastomosis potentially at. Acute cholangitis due to afferent loop syndrome after a. In 18 patients, in whom an afferent loop syndrome was clinically suspected, hepatobiliary scanning demonstrated an altered afferent loop emptying in 8 and atonic distension. The afferent loop syndrome appears to result from rapid gastric emptying and distention by foodstimulated pancreatic and biliary secretions of an incompletely draining, partially obstructed billroth ii afferent loop. Partial gastrectomy and reconstruction huntlawrence pouch for esophagojejunostomy roux en y gastric bypass afferent and efferent loop obstruction afferent and efferent loops reoperation for afferent loop syndrome schematic drawing of jejunogastric intussusception. The loop carrying food away from the stomach is called the efferent loop. Afferent loop syndrome is an uncommon complication most often associated with billroth ii reconstruction in which the afferent loop becomes obstructed owing to. It is similar to the blind loop syndrome seen with sidetoside intestinal anastomosis 4. In a loop syndrome, a portion or limb of the small intestine becomes blocked. Management of afferent loop syndrome after rouxeny subtotal.
Creation of an anastomosis between the stomach and jejunum leaves a segment of the small bowel, most commonly consisting of the duodenum and proximal jejunum, lying upstream from the gastrojejunostomy. An obstruction of the afferent limb can present in various ways. The chart showing pdf series, word series, html series, scan qr codes. Afferent loop syndrome after whipple procedure sages. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The content on the uptodate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment.
Efferent loop syndrome is one of two loop syndromes that can happen after some types of gastric surgery. Afferent loop syndrome is a rare complication after gastrectomy with billroth ii or rouxeny reconstruction, caused by an obstruction in the proximal loop. Efferent loop syndrome health encyclopedia university. Whipple procedures are mainly used to treat patients with pancreatic head and periampullary tumors as well as for those with chronic pain syndrome. Endoscopic treatment of efferent loop syndrome with insertion. Afferent loop syndrome is an intermittent partial or complete mechanical obstruction of the afferent limb of a gastrojejunostomy the syndrome classically refers to obstruction of the upstream limb of a sidetoside gastrojejunostomy but has also been used to refer to the biliopancreatic limb of a rouxeny gastrojejunostomy. Technetium99m hida hepatobiliary scanning in evaluation. In order to decompress the afferent loop dilatation due to adhesions, a laterallateral jejunal anastomosis was performed between the afferent loop and a small bowel loop. The efferent loop syndrome in a narrow sense refers only to obstruction of the efferent jejunal loop after gastric resection or simple gastroenterostomy. Afferent loop syndrome health encyclopedia university. Fifty patients were investigated by means of technetium99m hida hepatobiliary scanning. The als corresponds to an acute or chronic obstruction of the afferent loop following a gastrectomy operation with gastrojejunal anastomosis 2. May 15, 2019 afferent loop syndrome als is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy.
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