A Case of Afferent Loop Syndrome Successfully Treated with Effective Endoscopic Drainage Followed by Elective Surgery

Abstract

Afferent loop syndrome is a severe post-operative complication, which needs prompt diagnosis and treatment. We describe herein a case of afferent loop syndrome 35 years after distal gastrectomy, which could be diagnosed in an early stage, and successfully treated by elective surgery following endoscopic drainage. A 68-year-old man was admitted to our hospital complaining of abdominal distention and palpitation. His past history included a distal gastrectomy performed 35 years previously. Computed tomography revealed a dilated duodenum and findings suggestive of acute pancreatitis, and the afferent loop stenosis of the Billroth-II reconstruction was confirmed with contrast radiography of the upper gastrointestinal tract as well as the endoscopic examination. The diagnosis of acute afferent loop syndrome was made, and the endoscopic drainage of the afferent loop using a transnasal tube was indicated. This transnasal tube was later replaced by a longer, wider-diameter tube to allow adequate drainage, and the contrast radiography performed thereafter reveled duodenal perforation to the retro-peritoneal space, which was conservatively treated by drainage. The symptoms improved gradually, and after the removal of the long tube, the patient underwent elective surgery to prevent recurrence. The previous operation was a gastrectomy with Billroth-II reconstruction without Brauns anastomosis in the anterior anastomosis of the colon. The afferent loop was long, turned and twisted, which probably caused the stenosis. The stenosis was removed and Brauns anastomosis performed. The patient had a favorable progression and was discharged on the 11th post-operative day.