Afferent loop syndrome complicated by a duodenal phytobezoar after Billroth-II subtotal gastrectomy

We illustrate a rare late onset (10 yr) complication of gastric surgery with a combination of afferent loop syndrome and a large duodenal bezoar. The patient underwent a subtotal gastrectomy with Billroth II gastrojejunal anastomosis for benign peptic ulcer 10 yr ago. It was not until several days before this presentation that he suffered from epigastralgia and abdominal distension. Leukocytosis and abnormal blood biochemistry were found including amylase, lipase, alkaline phosphatase, total bilirubin, GOT, and GPT in which amylase was markedly elevated to 1188 U/L. Abdominal ultrasound scan and especially CT scan confirmed the diagnosis of a large bezoar in the dilated duodenal afferent loop. To our knowledge, the rare entity in our case is the first reported in the literature.