A Case of Duodenal Necrosis Due to Afferent Limb Dilatation Caused by Dietary Obstruction After Gastrectomy

Abstract

We report a rare case of duodenal necrosis caused by afferent loop syndrome following food bolus-induced efferent limb obstruction after gastrectomy, which was successfully treated by pancreaticoduodenectomy. A 64-year-old male patient with a history of laparoscopic-assisted distal gastrectomy with Roux-en-Y reconstruction for early gastric cancer 11 years prior presented with acute abdominal pain. The symptom developed after he had consumed shirataki noodles at dinner, prompting emergency medical evaluation. On arrival, physical examination revealed abdominal distension, epigastric tenderness, and signs of peritoneal irritation. Computed tomography (CT) revealed a food bolus extending from the efferent limb to the afferent limb, with marked duodenal dilatation and poor contrast enhancement of the duodenal wall, suggestive of necrosis. Based on these findings, we performed emergency laparotomy. Intraoperatively, we found discoloration of the duodenum proximal to the ligament of Treitz, with rupture and necrosis of the serosa of the descending duodenum, but no evidence of internal or strangulation; the condition was attributed to afferent limb distension caused by accumulation of a food bolus extending from the Y limb to the efferent limb. Given the extensive duodenal necrosis, we performed pancreaticoduodenectomy. The postoperative course was complicated by pancreatic fistula formation, which was managed conservatively. The patient was discharged on postoperative day 36. Dietary obstruction due to a food bolus can lead to afferent limb rupture and duodenal necrosis. Therefore, postoperative dietary education is essential for patients following gastrectomy.