Enterolith Causing Afferent Loop Perforation After Distal Gastrectomy.

Area of Science:

• Gastroenterology
• Surgical Complications
• Abdominal Surgery

Background:

• Afferent loop syndrome is a known complication following gastric surgery, particularly Billroth II or Roux-en-Y reconstructions.
• Enteroliths, or calculus concretions within the intestine, can obstruct the afferent limb, leading to complications.
• Duodenal perforation is a rare but severe manifestation of afferent loop syndrome.

Observation:

• A 73-year-old female presented with acute abdominal pain 14 years after distal gastrectomy and Roux-en-Y reconstruction for gastric cancer.
• Emergency surgery revealed afferent loop syndrome secondary to an enterolith causing duodenal perforation.
• The patient underwent enterolith removal, drain placement, and duodenal decompression tube insertion.

Findings:

• Surgical removal of the enterolith and decompression of the duodenum were the primary interventions.
• Postoperative management included percutaneous drainage of an intra-abdominal abscess.
• The patient recovered without requiring reoperation.

Implications:

• This case highlights that afferent loop obstruction by enteroliths can lead to duodenal perforation.
• Surgical intervention, including enterolith removal and afferent loop decompression, is a crucial treatment modality.
• Prompt surgical management can prevent severe morbidity and mortality associated with this complication.