eMedicine Specialties > Gastroenterology > Intestine

Afferent Loop Syndrome: Follow-up

Author: Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Coauthor(s): Michael AJ Sawyer, MD, Consulting Staff, Department of Surgery, Southwestern Medical Center; Consulting Staff, Department of Surgery, Comanche County Memorial Hospital; Consulting Staff, Great Plains Surgical Clinic, Inc; Robert A Decker, MD, Clinical Assistant Professor, Department of Medicine, University of Hawaii at Manoa: Chief, Gastroenterology Service, Kaiser Permanente Medical Center of Honolulu
Contributor Information and Disclosures

Updated: Nov 16, 2009

Outcome and Prognosis

After a proper corrective procedure, the prognosis is usually very good, except in cases of advanced or recurrent malignancy.

Future and Controversies

Medicolegal pitfalls

The major medicolegal pitfall associated with ALS is a delay in diagnosis. This is most serious with acute ALS because diagnostic delay can lead to bowel perforation or gangrene with resultant intra-abdominal sepsis.

 


More on Afferent Loop Syndrome

Overview: Afferent Loop Syndrome
Workup: Afferent Loop Syndrome
Treatment: Afferent Loop Syndrome
Follow-up: Afferent Loop Syndrome
Multimedia: Afferent Loop Syndrome
References
[ CLOSE WINDOW ]

References

  1. Roberts KE, Randall HT, Farr HW, Kidwell AP, Mcneer GP, Pack GT. Cardiovascular and blood volume alterations resulting from intrajeunal administration of hypertonic solutions to gastrectomized patients: the relationship of these changes to the dumping syndrome. Ann Surg. Nov 1954;140(5):631-40. [Medline].

  2. Shultz KT, Neelon FA, Nilsen LB, Lebovitz HE. Mechanism of postgastrectomy hypoglycemia. Arch Intern Med. Aug 1971;128(2):240-6. [Medline].

  3. Emas S, Fernstrom M. Prospective, randomized trial of selective vagotomy with pyloroplasty and selective proximal vagotomy with and without pyloroplasty in the treatment of duodenal, pyloric, and prepyloric ulcers. Am J Surg. Feb 1985;149(2):236-43. [Medline].

  4. Hom S, Sarr MG, Kelly KA, Hench V. Postoperative gastric atony after vagotomy for obstructing peptic ulcer. Am J Surg. Mar 1989;157(3):282-6. [Medline].

  5. Gustavsson S, Ilstrup DM, Morrison P, Kelly KA. Roux-Y stasis syndrome after gastrectomy. Am J Surg. Mar 1988;155(3):490-4. [Medline].

  6. Delcore R, Cheung LY. Surgical options in postgastrectomy syndromes. Surg Clin North Am. Feb 1991;71(1):57-75. [Medline].

  7. Ritchie WP Jr. Alkaline reflux gastritis. An objective assessment of its diagnosis and treatment. Ann Surg. Sep 1980;192(3):288-98. [Medline].

  8. Eagon JC, Miedema BW, Kelly KA. Postgastrectomy syndromes. Surg Clin North Am. Apr 1992;72(2):445-65. [Medline].

  9. Roux G, Pedoussaut R, Marchal G. [Afferent loop syndrome of gastrectomized subjects.]. Lyon Chir. Oct 1950;45(7):773-80. [Medline].

  10. Wells C, Welbourn R. Post-gastrectomy syndromes; a study in applied physiology. Br Med J. Mar 17 1951;1(4706):546-54. [Medline].

  11. Burkhalter E. Incidence of gastrectomy in United States army hospitals worldwide from 1975 to 1985. Am J Gastroenterol. Nov 1988;83(11):1231-4. [Medline].

  12. Paimela H, Tuompo PK, Perakyl T, Saario I, Hockerstedt K, Kivilaakso E. Peptic ulcer surgery during the H2-receptor antagonist era: a population-based epidemiological study of ulcer surgery in Helsinki from 1972 to 1987. Br J Surg. Jan 1991;78(1):28-31. [Medline].

  13. Tovey FI, Godfrey JE, Lewin MR. A gastrectomy population: 25-30 years on. Postgrad Med J. Jun 1990;66(776):450-6. [Medline].

  14. Ogata M, Ishikawa T. Acute afferent loop obstruction caused by retroanastomotic hernia. J Ultrasound Med. Nov 1993;12(11):697-9. [Medline].

  15. Tsutsui S, Kitamura M, Shirabe K, Baba H, Sugimachi K. Afferent loop syndrome due to scarring of a stomal ulcer following a Billroth II gastrectomy. Endoscopy. Jun 1995;27(5):410. [Medline].

  16. Carbognin G, Biasiutti C, El-Khaldi M, Ceratti S, Procacci C. Afferent loop syndrome presenting as enterolith after Billroth II subtotal gastrectomy: a case report. Abdom Imaging. Mar-Apr 2000;25(2):129-31. [Medline].

  17. Hui MS, Perng HL, Choi WM, Chem LK, Yang KC, Chen TJ. Afferent loop syndrome complicated by a duodenal phytobezoar after Billroth-II subtotal gastrectomy. Am J Gastroenterol. Sep 1997;92(9):1550-2. [Medline].

  18. Bushkin FL, Woodward ER. The afferent loop syndrome. Major Probl Clin Surg. 1976;20:34-48. [Medline].

  19. Locke GR, Alexander GL, Sarr MG. Obstructive jaundice: an unusual presentation of afferent loop obstruction. Am J Gastroenterol. Jun 1994;89(6):942-4. [Medline].

  20. Rana SV, Bhardwaj SB. Small intestinal bacterial overgrowth. Scand J Gastroenterol. 2008;43(9):1030-7. [Medline].

  21. Ballas KD, Rafailidis SE, Konstantinidis HD, et al. Acute afferent loop syndrome: a true emergency. A case report. Acta Chir Belg. Jan-Feb 2009;109(1):101-3. [Medline].

  22. Golioto M. A woman with abdominal pain and bilious vomiting. A very late aftermath of Billroth II gastrectomy. N C Med J. Nov-Dec 2000;61(6):338-40. [Medline].

  23. Kitamura H, Miwa S, Nakata T, Nomura K, Tanaka T, Ikegami T, et al. Sonographic detection of visceral adhesion in percutaneous drainage of afferent-loop small-intestine obstruction. J Clin Ultrasound. Mar 2000;28(3):133-6. [Medline].

  24. Derchi LE, Bazzocchi M, Brovero PL. Sonographic diagnosis of obstructed afferent loop. Gastrointest Radiol. 1992;17(2):105-7. [Medline].

  25. Lee DH, Lim JH, Ko YT. Afferent loop syndrome: sonographic findings in seven cases. AJR Am J Roentgenol. Jul 1991;157(1):41-3. [Medline].

  26. Matsusue S, Kashihara S, Takeda H, Koizumi S. Three cases of afferent loop obstruction--the role of ultrasonography in the diagnosis. Jpn J Surg. Nov 1988;18(6):709-13. [Medline].

  27. Lai FM, Paramsothy M, George J, Yip CH. The role of 99mtechnetium (Tc) diethyl-iminodiacetic acid (EHIDA) hepatobiliary scintigraphy in the diagnosis of a rare cause of obstructive jaundice. Singapore Med J. Jun 1996;37(3):261-3. [Medline].

  28. Sivelli R, Farinon AM, Sianesi M, Percudani M, Ugolotti G, Calbiani B. Technetium-99m HIDA hepatobiliary scanning in evaluation of afferent loop syndrome. Am J Surg. Aug 1984;148(2):262-5. [Medline].

  29. Yilmaz S, Yekeler E, Dural C, et al. Afferent loop syndrome secondary to Billroth II gastrojejunostomy obstruction: Multidetector computed tomography findings. Surgery. Apr 2007;141(4):538-9. [Medline].

  30. Zissin R, Hertz M, Paran H, Osadchy A, Gayer G. Computed tomographic features of afferent loop syndrome: pictorial essay. Can Assoc Radiol J. Apr 2005;56(2):72-8. [Medline].

  31. Kim HC, Han JK, Kim KW, Kim YH, Yang HK, Kim SH, et al. Afferent loop obstruction after gastric cancer surgery: helical CT findings. Abdom Imaging. Sep-Oct 2003;28(5):624-30. [Medline].

  32. Gayer G, Barsuk D, Hertz M, Apter S, Zissin R. CT diagnosis of afferent loop syndrome. Clin Radiol. Sep 2002;57(9):835-9. [Medline].

  33. Gale ME, Gerzof SG, Kiser LC, Snider JM, Stavis DM, Larsen CR, et al. CT appearance of afferent loop obstruction. AJR Am J Roentgenol. Jun 1982;138(6):1085-8. [Medline].

  34. Swayne LC, Love MB. Computed tomography of chronic afferent loop obstruction: a case report and review. Gastrointest Radiol. 1985;10(1):39-41. [Medline].

  35. Kuwabara Y, Nishitani H, Numaguchi Y, Kamoi I, Matsuura K, Saito S. Afferent loop syndrome. J Comput Assist Tomogr. Oct 1980;4(5):687-9. [Medline].

  36. Chevallier P, Gueyffier C, Souci J, Oddo F, Diaine B, Padovani B. [MRI of an afferent loop syndrome presenting as obstructive icterus]. J Radiol. Feb 2001;82(2):177-9. [Medline].

  37. McKee JD, Raju GP, Edelman RR, Levine H, Steer M, Chuttani R. MR cholangiopancreatography (MRCP) in diagnosis of afferent loop syndrome presenting as cholangitis. Dig Dis Sci. Oct 1997;42(10):2082-6. [Medline].

  38. Ashida A, Tamura I, Kumagiri Y, et al. Magnetic resonance cholangiopancreatography for afferent loop syndrome. ANZ J Surg. Jan-Feb 2008;78(1-2):91-2. [Medline].

  39. Yavuz N, Erguney S, Ogut G, Alver O. Enteroliths developed in a chronically obstructed afferent loop coexisting with gastric remnant carcinoma: Case report and review of the literature. J Gastroenterol Hepatol. Mar 2006;21(3):495-8. [Medline].

  40. Kim YH, Han JK, Lee KH, Kim TK, Kim KW, Choi BI. Palliative percutaneous tube enterostomy in afferent-loop syndrome presenting as jaundice: clinical effectiveness. J Vasc Interv Radiol. Aug 2002;13(8):845-9. [Medline].

  41. Lee KD, Liu TW, Wu CW, Tiu CM, Liu JM, Chung TR, et al. Non-surgical treatment for afferent loop syndrome in recurrent gastric cancer complicated by peritoneal carcinomatosis: percutaneous transhepatic duodenal drainage followed by 24-hour infusion of high-dose fluorouracil and leucovorin. Ann Oncol. Jul 2002;13(7):1151-5. [Medline].

  42. Caldicott DG, Ziprin P, Morgan R. Transhepatic insertion of a metallic stent for the relief of malignant afferent loop obstruction. Cardiovasc Intervent Radiol. Mar-Apr 2000;23(2):138-40. [Medline].

  43. Yoshida H, Mamada Y, Taniai N, Kawano Y, Mizuguchi Y, Shimizu T, et al. Percutaneous transhepatic insertion of metal stents with a double-pigtail catheter in afferent loop obstruction following distal gastrectomy. Hepatogastroenterology. May-Jun 2005;52(63):680-2. [Medline].

  44. Yoshida H, Mamada Y, Taniai N, et al. Afferent loop obstruction treated by percutaneous transhepatic insertion of an expandable metallic stent. Hepatogastroenterology. Sep-Oct 2008;55(86-87):1767-9. [Medline].

  45. Chevallier P, Novellas S, Motamedi JP, et al. Percutaneous jejunostomy and stent placement for treatment of malignant Roux-en-Y obstruction: a case report. Clin Imaging. Jul-Aug 2006;30(4):283-6.

  46. Song HY, Kim TH, Choi EK, et al. Metallic stent placement in patients with recurrent cancer after gastrojejunostomy. J Vasc Interv Radiol. Dec 2007;18(12):1538-46. [Medline].

  47. Kim HJ, Kim JW, Kim KH, et al. [A case of afferent loop syndrome treated by endoscopic drainage procedure using nasogastric tube] [Korean]. Korean J Gastroenterol. Mar 2007;49(3):173-6. [Medline].

  48. Borrelli D, Borrelli A, Presenti L, Bergamini C, Basili G. [Surgical approach of the functional post-partial gastrectomy syndromes] [Italian]. Ann Ital Chir. Jan-Feb 2007;78(1):3-10. [Medline].

  49. Vettoretto N, Pettinato G, Romessis M, Bravo AF, Barozzi G, Giovanetti M. Laparoscopy in afferent loop obstruction presenting as acute pancreatitis. JSLS. Apr-Jun 2006;10(2):270-4. [Medline].

  50. Aimoto T, Uchida E, Nakamura Y, Katsuno A, Chou K, Tajiri T, et al. Malignant afferent loop obstruction following pancreaticoduodenectomy: report of two cases. J Nippon Med Sch. Aug 2006;73(4):226-30. [Medline].

  51. Van Stiegmann G, Goff JS. An alternative to Roux-en-Y for treatment of bile reflux gastritis. Surg Gynecol Obstet. Jan 1988;166(1):69-70. [Medline].

  52. Mulholland MW, Magallanes F, Quigley TM, Delaney JP. In-continuity gastrointestinal stapling. Dis Colon Rectum. Sep 1983;26(9):586-9. [Medline].

  53. Aerts P, Leyman P, Verellen S, Van Steenberge R. Ultrasonography and computed tomography of afferent loop obstruction. J Belge Radiol. Dec 1993;76(6):390-1. [Medline].

  54. Fleser PS, Villalba M. Afferent limb volvulus and perforation of the bypassed stomach as a complication of Roux-en-Y gastric bypass. Obes Surg. Jun 2003;13(3):453-6. [Medline].

  55. Kaya E, Senyürek G, Dervisoglu A, Danaci M, Kesim M. Acute pancreatitis caused by afferent loop herniation after Billroth II gastrectomy: report of a case and review of the literature. Hepatogastroenterology. Mar-Apr 2004;51(56):606-8. [Medline].

  56. Lee LI, Teplick SK, Haskin PH, Sammon JK, Wolferth C, Amron G. Refractory afferent loop problems: percutaneous transhepatic management of two cases. Radiology. Oct 1987;165(1):49-50. [Medline].

  57. Mann NS, Rachut E. Carcinoma of gastric stump causing afferent loop obstruction and acute pancreatitis. Hepatogastroenterology. Jan-Feb 2004;51(55):184-5. [Medline].

  58. Morii Y, Arita T, Shimoda K, Yasuda K, Matsui Y, Inomata M, et al. Jejunal interposition to prevent postgastrectomy syndromes. Br J Surg. Nov 2000;87(11):1576-9. [Medline].

  59. Moriura S, Takayama Y, Nagata J, Akutagawa A, Hirano A, Ishiguro S, et al. Percutaneous bowel drainage for jaundice due to afferent loop obstruction following pancreatoduodenectomy: report of a case. Surg Today. 1999;29(10):1098-101. [Medline].

  60. Morse JM, Lakshman S, Thomas E. "Pseudogallbladder" appearance in partial afferent loop obstruction in a patient with cholecystectomy. South Med J. Aug 1986;79(8):1030-3. [Medline].

  61. Muthukrishnan A, Shanthly N, Kumar S. Afferent loop syndrome: the role of Tc-99m mebrofenin hepatobiliary scintigraphy. Clin Nucl Med. Jun 2000;25(6):492-4. [Medline].

  62. Taylor AR, Russ PD, Lee RE, Weingardt JP. Acute afferent loop obstruction diagnosed with computed tomography: case report. Can Assoc Radiol J. Aug 1999;50(4):251-4. [Medline].

  63. Tien YW, Lee PH, Chang KJ. Enterolith: an unusual cause of afferent loop obstruction. Am J Gastroenterol. May 1999;94(5):1391-2. [Medline].

  64. Woodfield CA, Levine MS. The postoperative stomach. Eur J Radiol. Mar 2005;53(3):341-52. [Medline].

  65. Yao NS, Wu CW, Tiu CM, Liu JM, Whang-Peng J, Chen LT. Percutaneous transhepatic duodenal drainage as an alternative approach in afferent loop obstruction with secondary obstructive jaundice in recurrent gastric cancer. Cardiovasc Intervent Radiol. Jul-Aug 1998;21(4):350-3. [Medline].

  66. Zissin R. CT findings of afferent loop syndrome after a subtotal gastrectomy with Roux-en-Y reconstruction. Emerg Radiol. Feb 2004;10(4):201-3. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

afferent loop syndrome, ALS, Billroth II gastrojejunostomy, hernia, volvulus, intussusception, blind loop syndrome, proximal loop syndrome, postgastrectomy syndromes, late dumping syndrome, intestinal obstruction,

postvagotomy diarrhea, chronic gastric atony, Roux stasis syndrome, small gastric remnant syndrome, alkaline reflux gastritis, efferent loop syndrome, peptic ulcer disease, PUD, gastrojejunal loop obstruction, gastrojejunostomy, Billroth II-type gastrectomy, pancreaticoduodenectomy, esophagogastroduodenoscopy, EGD, Billroth I gastroduodenostomy, Roux-en-Y gastrojejunostomy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Michael AJ Sawyer, MD, Consulting Staff, Department of Surgery, Southwestern Medical Center; Consulting Staff, Department of Surgery, Comanche County Memorial Hospital; Consulting Staff, Great Plains Surgical Clinic, Inc
Michael AJ Sawyer, MD is a member of the following medical societies: American College of Surgeons, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Robert A Decker, MD, Clinical Assistant Professor, Department of Medicine, University of Hawaii at Manoa: Chief, Gastroenterology Service, Kaiser Permanente Medical Center of Honolulu
Disclosure: Nothing to disclose.

Medical Editor

Rajeev Vasudeva, MD, FACG, Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine
Rajeev Vasudeva, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Columbia Medical Society, South Carolina Gastroenterology Association, and South Carolina Medical Association
Disclosure: Pricara Honoraria Speaking and teaching; UCB Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Douglas M Heuman, MD, FACP, FACG, AGAF, Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine
Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.