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[Acute pancreatitis and afferent loop syndrome. Case report]
Elpidio Manuel Barajas-Fregoso1, Teodoro Romero-Hernández2, Michel Dassaejv Macías-Amezcua3
1Cirugía General, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, México DF, Mexico. embarajas_84@hotmail.com.
Cirugia Y Cirujanos
|August 16, 2014
Summary
Afferent loop syndrome, a complication of gastric surgery, causes severe pancreatitis due to obstruction. Early recognition and management are crucial for patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Complications
- Pancreatology
Background:
- Afferent loop syndrome results from mechanical obstruction in the afferent limb following Billroth II or Roux-Y gastrointestinal reconstructions.
- It is often a consequence of distal or subtotal gastrectomy procedures.
- This condition presents a significant risk, particularly after specific types of gastric surgery.
Observation:
- A 76-year-old male presented with acute abdominal pain, nausea, vomiting, and distension.
- Laboratory results revealed markedly elevated amylase (1246 U/L) and lipase (3381 U/L).
- Computed tomography confirmed afferent loop distension and pancreatic enlargement, indicative of acute pancreatitis.
Findings:
- The patient's symptoms and diagnostic imaging were consistent with acute pancreatitis secondary to afferent loop syndrome.
- The obstruction led to the accumulation of biliary and intestinal secretions, causing loop distension.
- Elevated pancreatic enzymes confirmed the inflammatory response within the pancreas.
Implications:
- Afferent loop syndrome occurs in 0.3%-1% of Billroth II reconstructions, carrying a mortality rate up to 57%.
- Obstruction causes dilation of the afferent limb and pancreatic/biliary ducts, leading to pancreatitis.
- The severity of afferent loop syndrome correlates directly with the degree and duration of the obstruction.
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