Afferent Loop Syndrome Questions & Answers

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

2. Rana SV, Bhardwaj SB. Small intestinal bacterial overgrowth. Scand J Gastroenterol. 2008. 43(9):1030-7. [QxMD MEDLINE Link].

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8. Delcore R, Cheung LY. Surgical options in postgastrectomy syndromes. Surg Clin North Am. 1991 Feb. 71(1):57-75. [QxMD MEDLINE Link].

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

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11. Roux G, Pedoussaut R, Marchal G. [Afferent loop syndrome of gastrectomized subjects.]. Lyon Chir. 1950 Oct. 45(7):773-80. [QxMD MEDLINE Link].

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

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

14. 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. 1995 Jun. 27(5):410. [QxMD MEDLINE Link].

15. 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. 2000 Mar-Apr. 25(2):129-31. [QxMD MEDLINE Link].

16. Kim HJ, Moon JH, Choi HJ, et al. Endoscopic removal of an enterolith causing afferent loop syndrome using electrohydraulic lithotripsy. Dig Endosc. 2010 Jul. 22(3):220-2. [QxMD MEDLINE Link].

17. Alves AR, Almeida N, Ferreira M, Tome L. Endoscopic management of afferent loop syndrome caused by enteroliths and anastomotic stricture. A case report. Rev Esp Enferm Dig. 2017 Jun. 109(6):457. [QxMD MEDLINE Link]. [Full Text].

18. Cho YS, Lee TH, Hwang SO, et al. Electrohydraulic lithotripsy of an impacted enterolith causing acute afferent loop syndrome. Clin Endosc. 2014 Jul. 47(4):367-70. [QxMD MEDLINE Link]. [Full Text].

19. 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. 1997 Sep. 92(9):1550-2. [QxMD MEDLINE Link].

20. Bushkin FL, Woodward ER. The afferent loop syndrome. Major Probl Clin Surg. 1976. 20:34-48. [QxMD MEDLINE Link].

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

22. 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. 1991 Jan. 78(1):28-31. [QxMD MEDLINE Link].

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

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

25. Valdivielso Cortazar E, Redondo Martinez J, Romay Cousido G, Alonso-Aguirre P. Cholangitis secondary to afferent loop syndrome from a gastric stump adenocarcinoma. Rev Esp Enferm Dig. 2018 Apr. 110(4):253. [QxMD MEDLINE Link]. [Full Text].

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

27. Yue P, Meng W, Luo Z, Bai B, Li X. Double pigtail stents healed acute pancreatitis resulting from afferent loop obstruction. Turk J Gastroenterol. 2018 Nov. 29 (6):705-7. [QxMD MEDLINE Link]. [Full Text].

28. Kitamura H, Miwa S, Nakata T, et al. Sonographic detection of visceral adhesion in percutaneous drainage of afferent-loop small-intestine obstruction. J Clin Ultrasound. 2000 Mar. 28(3):133-6. [QxMD MEDLINE Link].

29. Derchi LE, Bazzocchi M, Brovero PL. Sonographic diagnosis of obstructed afferent loop. Gastrointest Radiol. 1992. 17(2):105-7. [QxMD MEDLINE Link].

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

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

32. 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. 1996 Jun. 37(3):261-3. [QxMD MEDLINE Link].

33. 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. 1984 Aug. 148(2):262-5. [QxMD MEDLINE Link].

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

35. Juan YH, Yu CY, Hsu HH, et al. Using multidetector-row CT for the diagnosis of afferent loop syndrome following gastroenterostomy reconstruction. Yonsei Med J. 2011 Jul. 52(4):574-80. [QxMD MEDLINE Link]. [Full Text].

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

37. Kim HC, Han JK, Kim KW, et al. Afferent loop obstruction after gastric cancer surgery: helical CT findings. Abdom Imaging. 2003 Sep-Oct. 28(5):624-30. [QxMD MEDLINE Link].

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

39. Gale ME, Gerzof SG, Kiser LC, et al. CT appearance of afferent loop obstruction. AJR Am J Roentgenol. 1982 Jun. 138(6):1085-8. [QxMD MEDLINE Link].

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

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

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

43. 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. 1997 Oct. 42(10):2082-6. [QxMD MEDLINE Link].

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

45. Benallal DC, Hoibian S, Caillol F, et al. EUS-guided gastroenterostomy for afferent loop syndrome treatment stent. Endosc Ultrasound. 2018 Nov-Dec. 7(6):418-9. [QxMD MEDLINE Link]. [Full Text].

46. Dindar G, Sezikli M, Cam I, Turgut HT. A patient with abdominal pain and obstructive jaundice. Turk J Gastroenterol. 2018 Mar. 29(2):233-6. [QxMD MEDLINE Link]. [Full Text].

47. 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. 2006 Mar. 21(3):495-8. [QxMD MEDLINE Link].

48. 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. 2002 Aug. 13(8):845-9. [QxMD MEDLINE Link].

49. Lee KD, Liu TW, Wu CW, 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. 2002 Jul. 13(7):1151-5. [QxMD MEDLINE Link].

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

51. Yoshida H, Mamada Y, Taniai N, et al. Percutaneous transhepatic insertion of metal stents with a double-pigtail catheter in afferent loop obstruction following distal gastrectomy. Hepatogastroenterology. 2005 May-Jun. 52(63):680-2. [QxMD MEDLINE Link].

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

53. 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. 2006 Jul-Aug. 30(4):283-6.

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

55. 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. 2007 Mar. 49(3):173-6. [QxMD MEDLINE Link].

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

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

58. Aimoto T, Uchida E, Nakamura Y, et al. Malignant afferent loop obstruction following pancreaticoduodenectomy: report of two cases. J Nippon Med Sch. 2006 Aug. 73(4):226-30. [QxMD MEDLINE Link].

59. Han K, Song HY, Kim JH, et al. Afferent loop syndrome: treatment by means of the placement of dual stents. AJR Am J Roentgenol. 2012 Dec. 199(6):W761-6. [QxMD MEDLINE Link].

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

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

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

63. Gwon DI. Percutaneous transhepatic placement of covered, self-expandable nitinol stent for the relief of afferent loop syndrome: report of two cases. J Vasc Interv Radiol. 2007 Jan. 18(1 pt 1):157-63. [QxMD MEDLINE Link].

64. Moriura S, Takayama Y, Nagata J, 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. [QxMD MEDLINE Link].

65. Cha RR, Cho SB, Kim WS, et al. Self-expanding metal stent procedure for afferent loop syndrome with ascending cholangitis caused by remnant gastric cancer: A case report. Medicine (Baltimore). 2018 Dec. 97(50):e13072. [QxMD MEDLINE Link]. [Full Text].

66. Morita S, Takemura T, Matsumoto S, Odani R. Septic shock after percutaneous transhepatic drainage of obstructed afferent loop: case report. Cardiovasc Intervent Radiol. 1989 Mar-Apr. 12(2):66-8. [QxMD MEDLINE Link].

67. Burke DR, Weinstein JK. Malignant jejunal strictures after Whipple procedure: stenting with large-bore tubes and use of combined transhepatic and peroral approach. Radiology. 1988 Oct. 169(1):258-60. [QxMD MEDLINE Link].

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

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

70. Kaya E, Senyurek 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. 2004 Mar-Apr. 51(56):606-8. [QxMD MEDLINE Link].

71. Woodfield CA, Levine MS. The postoperative stomach. Eur J Radiol. 2005 Mar. 53(3):341-52. [QxMD MEDLINE Link].

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

73. Takata K, Anan A, Umeda K, Sakisaka S. Magnetic resonance cholangiopancreatography for afferent loop syndrome. Clin Case Rep. 2019 Mar. 7(3):591-2. [QxMD MEDLINE Link]. [Full Text].

74. Kanno Y, Ohira T, Harada Y, et al. Metal stent placement in the afferent loop obstructed by peritoneal metastases - experience of five cases. Clin Endosc. 2018 May. 51(3):299-303. [QxMD MEDLINE Link]. [Full Text].

75. Yokoyama S, Ueno K, Higashide Y, et al. Short- and long-term outcomes after pancreaticoduodenectomy following total gastorectomy: Report of case series and literature review. Int J Surg Case Rep. 2017. 30:118-21. [QxMD MEDLINE Link]. [Full Text].

76. Tsuji K, Takemura K, Inaki N, Doyama H. Pancreatitis due to afferent loop obstruction. Intern Med. 2013. 52(22):2589. [QxMD MEDLINE Link]. [Full Text].

Suresh Kumar Nayudu, MD Fellow in Gastroenterology, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University

Suresh Kumar Nayudu, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Medical Society of the State of New York, American Association of Physicians of Indian Origin, Americas Hepato-Pancreato-Biliary Association

Disclosure: Nothing to disclose.

Haritha Reddy Chelimilla, MD Fellow, Department of Gastroenterology, Bronx-Lebanon Hospital Center

Haritha Reddy Chelimilla, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Medical Association, Medical Society of the State of New York, Indian Medical Association, New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Prospere Remy, MD Assistant Professor of Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Internal Medicine, Bronx-Lebanon Hospital Center

Prospere Remy, MD is a member of the following medical societies: American College of Physicians, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Hassan Tariq, MD Chief Resident, Department of Medicine, Bronx Lebanon Hospital Center

Hassan Tariq, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Rajeev Vasudeva, MD Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine

Rajeev Vasudeva, MD 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, South Carolina Medical Association

Disclosure: Received honoraria from Pricara for speaking and teaching; Received consulting fee from UCB for consulting.

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.

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

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership 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.

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