A Case of Severe Acute Pancreatitis Caused by Afferent Loop Syndrome after Gastrectomy with Billroth-II Reconstruction

Abstract

The patient was a 66-year-old man who underwent gastrectomy with Billroth II reconstruction for duodenal ulcer perforation 29 years earlier and had a history of conservative treatment for afferent loop syndrome. Computed tomography (CT) showed dilation of the afferent loop and an increased concentration of peripancreatic fat. The patient was admitted to the hospital with a diagnosis of acute pancreatitis due to afferent loop syndrome. A nasogastric tube was placed in the afferent loop under endoscopy for decompression. Despite sufficient decompression of the afferent loop, severe acute pancreatitis progressed, and CT on the 10th day of admission showed extensive abscess formation from the lower mediastinum to the caudal space of the left kidney. At the stage of encapsulation, open necrosectomy and Braun anastomosis were performed on the 29th day of admission. After the operation, the inflammatory complication (minor leakage) subsided with drain management, and the patient was discharged on the 77th day of admission. Although the afferent loop syndrome rarely causes acute pancreatitis, the mortality rate is high when the pancreatitis becomes severe. It is important to keep in mind that there is a possibility that afferent loop syndrome leads to severe acute pancreatitis even after decompression of the afferent loop.