Abstract
A 54-year-old man, who four months previously had undergone a total gastrectomy with Roux-en-Y reconstruction, developed abdominal distension and pain in the upper abdomen. Blood tests revealed elevated levels of hepatobiliary and pancreatic enzymes. Abdominal X-ray films were unremarkable. Abdominal CT scan showed a markedly dilated intestine with fluid accumulation and a small amount of ascites. The pancreas was quitet swollen. The dilated intestine was thought to be the afferent loop ; a strangulating ileus of the afferent loop of the small intestine was diagnosed. On laparotomy, a strangulation of a segment of the afferent loop was identified ; the anastomotic site was rotated 180 degrees clockwise. Manual release of the rotation quickly restored a pink tint to the strangulated intestine. Perioperative management was centered on the treatment of the patient's acute pancreatitis ; the patient was discharged having had an uneventful post operative course. Since afferent loop ileus may present without vomiting and show a gasless ileus, prompt diagnosis using CT is mandatory.
