A case of recurrence of gastric cancer with acute afferent loop syndrome 4 years and 5 months after total gastrectomy

Abstract

Acute afferent loop syndrome is a comparatively rare complication following gastrectomy. We report a case of recurrence of gastric cancer with acute afferent loop syndrome 4 years and 5 months after total gastrectomy, together with a review of the literature.
An 85-year-old man with a history of undergoing total gastrectomy for advanced gastric cancer was admitted to our hospital because of abdominal pain and vomiting. Abdominal ultrasonography and CT scan showed a dilated afferent loop, dilated bile duct and common pancreatic duct, and an extremely swollen gallblaldder. He was diagnosed as having acute afferent loop syndrome. Endoscopic decompression of the afferent loop was unsuccessful, so emagency laparotomy was done. At laparotomy, we saw that he had undergone total gastrectomy with Roux en-Y reconstruction. The afferent loop proximal to the Treitz ligament was entremely dilated, but the loop distal to the ligament and the anastomosis of jejuno-jejunostomy were almost intact. No causes of obstruction of the afferent loop could not be identified. Because of haemodynamic instability, a new Roux en-Y reconstruction was perfomed through the retro-colic route. The patient was discharged from our hospital on the postoperative day 23.
Afferent loop syndrome carries very poor prognosis and hence it demands early diagnosis and prompt treatment as possible as we can.