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Recurrent acute pancreatitis caused by afferent loop stricture after gastrectomy
1Department of Surgery, Massachusetts General Hospital, Boston, USA.
Archives of Surgery (Chicago, Ill. : 1960)
|May 1, 1996
Summary
Afferent loop stricture, a rare complication of Billroth II reconstruction, can cause recurrent acute pancreatitis years later. Surgical decompression offers lasting symptom relief for this condition.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Billroth II gastrojejunostomy is a common surgical procedure.
- Afferent loop obstruction is a rare but serious complication.
Observation:
- Three patients presented with recurrent acute pancreatitis 13-24 years post-Billroth II reconstruction.
- Symptoms included abdominal pain, vomiting, jaundice, hyperamylasemia, weight loss, and anemia.
- Diagnosis was established through history, barium studies, cholescintigraphy, and endoscopy.
Findings:
- Afferent loop stricture was identified as the cause of recurrent pancreatitis.
- Pathogenesis is linked to ischemic mucosal damage during surgery.
- Surgical decompression effectively resolved symptoms.
Implications:
- Afferent loop stricture should be considered in the differential diagnosis of recurrent pancreatitis in patients with prior gastrectomy and Billroth II reconstruction.
- Early diagnosis and surgical intervention are crucial for patient outcomes.