Afferent loop syndrome secondary to recurrent pancreatic adenocarcinoma post-Whipple procedure: case report

Afferent loop syndrome (ALS) is a rare but serious complication following pancreaticoduodenectomy, most often due to recurrent malignancy.

A 62-year-old male patient with stage IIb pancreatic ductal adenocarcinoma status post-Whipple procedure presented with acute abdominal pain, bowel obstruction, and sepsis after months of persistent watery diarrhea. Imaging demonstrated recurrent pancreatic malignancy causing obstruction of the pancreaticobiliary limb consistent with ALS. Blood cultures grew Klebsiella pneumoniae, confirming sepsis secondary to obstruction. Endoscopy revealed a severe non-traversable afferent limb stricture, and palliative decompression with uncovered metal stent placement resulted in rapid clinical improvement.

This case highlights the need for a high degree of suspicion for ALS in post-Whipple patients with nonspecific gastrointestinal symptoms, particularly in the setting of recurrent malignancy. The prolonged refractory diarrhea preceding acute obstruction illustrates an atypical presentation that may delay diagnosis. Early imaging and minimally invasive endoscopic intervention can provide effective palliation and prevent severe complications.