eMedicine Specialties > Gastroenterology > Intestine

Afferent Loop Syndrome: Treatment

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

Treatment

Medical Therapy

Acute ALS

In patients with acute ALS, a favorable outcome is correlated with an expedient diagnosis and corrective surgery. Medical therapy has no role, although nasogastric tube drainage may temporarily provide relief of symptoms while patients are resuscitated before surgery. Kim et al reported a case of a 67-year-old patient with ALS and coexisting acute pancreatitis who was not felt to be an ideal surgical candidate.47 As a result, the patient was treated with an endoscopically placed nasogastric/enteric tube, with excellent relief of symptoms.

Chronic ALS

Patients with chronic ALS can be severely malnourished and anemic. These patients may benefit from preoperative specialized nutritional support or transfusion before undergoing corrective surgery. However, surgery should not be delayed if symptoms and signs consistent with complete obstruction develop.

Surgical Therapy

The treatment of ALS is surgical. Conservative measures can be temporarily used to resuscitate the patient, but the definitive treatment is corrective surgery. When ALS is caused by recurrent or unresectable malignancies, successful palliation is frequently accomplished using interventional radiologic techniques. Several references are described in the preceding section.

Surgical correction is effected by deconstructing the Billroth II gastrojejunostomy and restoring gastrointestinal continuity with an alternate method. Several procedures have been described, but the 2 predominant operations are Billroth I gastroduodenostomy and Roux-en-Y gastrojejunostomy.

Interestingly, based on their retrospective study of 19 patients with postgastrectomy syndromes of whom 3 had ALS, Borrelli et al reported a significant proportion of patients required minor surgical intervention.48 The authors raised the question that in selected patients, laparoscopic surgery may be considered.

Vettoretto and associates reported a case of afferent loop obstruction caused by an adhesive band following distal gastrectomy and reconstruction for gastric cancer.49 The authors performed diagnostic laparoscopy and laparoscopic lysis of adhesions, resulting in resolution of the ALS.

Aimoto and colleagues described 2 cases of malignant ALS in patients who had undergone pancreaticoduodenectomy.50 In both patients, recurrence of pancreatic cancer was found at laparotomy. Bypass procedures were performed in each case to effect palliation.

Consultations: Early consultation with a surgeon is mandatory.

Preoperative Details

The patient is properly identified. The patient (or a legal representative) is counseled about the operation and signs the informed consent documents.

Intravenous access is established, and intravenous fluid resuscitation is begun. A nasogastric tube is placed to decompress the stomach, and preoperative antibiotics are administered.

Intraoperative Details

Billroth I gastroduodenostomy

This procedure creates a direct anastomosis between the stomach and duodenum. It is the most physiologic procedure and is therefore the operation of choice. Several factors may preclude its use, including previous subtotal gastrectomy or extensive scarring around the duodenum. In these situations, the surgeon may be unable to gain enough mobility on the stomach and duodenum to create an anastomosis without excessive tension.

Roux-en-Y gastrojejunostomy

For a Roux-en-Y gastrojejunostomy, the jejunum is divided several centimeters distal to the ligament of Treitz. The proximal portion of the distal jejunal segment is anastomosed to the stomach. The distal end of the Roux limb is anastomosed to the distal jejunal segment. This jejunojejunostomy is created approximately 40 cm downstream from the gastrojejunostomy in order to minimize the possibility of developing alkaline (bile) reflux gastritis.

Van Stiegmann and Goff described a variant of this operation in which the jejunum is not divided.51 This is the so-called uncut Roux-en-Y gastrojejunostomy. The procedure was developed to avoid Roux stasis syndrome, which was thought to be caused by interruption of jejunal intestinal pacesetting potentials.

In an uncut Roux procedure, a loop gastrojejunostomy is fashioned. The afferent limb of this loop is occluded—but not divided—by a staple line. A jejunojejunostomy is made between the afferent and efferent jejunal limbs just proximal to the occluding staple line. This operation has not gained wide acceptance, partially because of the problem of dehiscence of the occluding staple line, as reported by Mulholland and colleagues.52

Other surgical procedures

The following remedial operations have also been used:

  • Revision of the gastrojejunostomy
  • Side-to-side enteroenterostomy
  • Jejunal segment interposition (between the gastric remnant and duodenum to create a modified Billroth I–type anastomosis)
  • Resection of the redundant portion of the afferent jejunal loop

Postoperative Details

Intravenous fluids

Resuscitative and maintenance intravenous fluids are provided postoperatively. These are usually administered as a balanced salt solution (eg, lactated Ringer solution). If the patient has hypochloremic metabolic alkalosis due to nasogastric suctioning or other causes, normal saline can be substituted. Intravenous fluid support is continued until the patient successfully resumes oral intake.

Activity

Early activity, including arising from the bed to a chair and ambulating frequently, is encouraged.

Diet and nutrition

Patients are kept nil per os (NPO) for varying durations depending on the preference of the operating surgeon. Because correction of ALS entails reoperative gastric and small bowel surgery, many surgeons choose to advance patients slowly.

Following nasogastric tube removal, patients can be started on liquids and advanced to a full diet as tolerated. Postgastrectomy diet counseling by a registered dietitian is helpful. Patients may find that they tolerate 5-6 smaller feedings per day better than the traditional 3 meals.

Depending on the patient's preoperative nutritional status, a period of specialized nutritional support might be warranted. This can range from enteral tube feedings to peripheral hyperalimentation to total parenteral nutrition. In addition, multivitamin and iron supplementation may be indicated.

Drains

A nasogastric tube is typically left in place postoperatively. Ensuring that the tube functions continuously and remains unclogged is crucial. Criteria for removal of a nasogastric tube include diminishing output and return of bowel function as manifested by bowel sounds or the passage of flatus.

A Foley catheter remains in place in the early postoperative period to monitor hydration status and to serve as a guide for fluid resuscitation. Once the patient is stabilized and no further major fluid shifts occur, the catheter can be removed.

Pulmonary toilet

Instruct patients to cough and to take frequent deep breaths. The incentive spirometer is an important adjunct and should be used every 1-2 hours while the patient is awake. Early mobilization of the patient assists with maintaining good pulmonary toilet.

Monitoring

Vital signs are monitored per protocol. Intake and output records are kept to monitor intravenous fluids given, oral intake, and urine and nasogastric tube outputs. Pulse oximetry may be used to measure oxygen saturation.

Antibiotics

Unless bowel perforation has occurred, a single dose of antibiotics as prophylaxis against wound infection usually suffices. Patients with abdominal catastrophes, such as bowel perforation or infarction, require a full course of antibiotic therapy aimed at gut flora.

Pain control

An epidural catheter can be placed by anesthesia personnel for postoperative pain control. Alternately, a patient-controlled anesthesia regimen can be ordered.

Deep venous thrombosis prophylaxis

Prophylaxis against deep venous thrombosis is crucial because deep venous thrombosis and pulmonary embolism are significant sources of postoperative morbidity and mortality. Available modalities include subcutaneous heparin, subcutaneous fractionated heparin preparations, and sequential compression stockings.

Aspiration precautions

The head of the bed can be kept elevated at 30-45° or sometimes higher in elderly patients or during sleep.

Follow-up

The operating surgeon should monitor patients to ensure that wound healing is complete and that no signs of infection arise. Patients are questioned about eating and elimination habits and are weighed to ensure that proper nutritional status is maintained.

Gastric emptying

Patients with persistent delayed gastric emptying or gastroparesis may report early satiety, epigastric fullness, nausea, or vomiting. Abdominal pain may be present. According to Gustavsson and associates, up to 30% of patients undergoing revision with a Roux-en-Y gastrojejunostomy develop one or more of these symptoms.5 This has been termed Roux stasis syndrome.

The workup for Roux stasis syndrome or simple gastric atony begins with upper gastrointestinal contrast studies to exclude a source of mechanical obstruction. Upper endoscopy can help determine if the patient has a mechanical problem (eg, anastomotic stricture). Radionuclide imaging is useful to confirm the diagnosis.

Conversely, patients may develop signs and symptoms of dumping syndrome following corrective surgery. While the diagnosis is primarily made based on clinical findings, radionuclide imaging helps confirm the diagnosis by demonstrating rapid gastric emptying.

Treating altered gastric emptying

For delayed gastric emptying, agents such as erythromycin and metoclopramide have been used with varying degrees of success. Patients with dumping syndrome can be given a low-carbohydrate diet and are instructed to limit fluid intake during meals. A somatostatin analog administered before meals has been successful in controlling dumping-related symptoms.

Hematopoiesis

CBC count and RBC characteristics are monitored. Patients with loss of parietal cell mass and bypass of the proximal small bowel may require supplemental iron and vitamin B-12.

Complications

Patients undergoing surgery for ALS are at risk for developing any of the following complications:

  • Wound infection
  • Wound dehiscence with or without evisceration
  • Urinary tract infection
  • Atelectasis
  • Pneumonia
  • Anastomotic disruption
  • Anastomotic stricture
  • Marginal ulceration
  • Intra-abdominal abscess formation
  • Cholangitis
  • Delayed gastric emptying/gastroparesis
  • Internal or enterocutaneous fistulae
  • Small bowel obstruction
  • Dumping syndrome
  • Alkaline reflux gastritis
  • Roux stasis syndrome
  • Cardiac arrhythmias
  • Deep venous thrombosis
  • Pulmonary embolism

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
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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].

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Further Reading

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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

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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.

 
 
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