Afferent loop syndrome: a different picture

A patient who had a 50% gastrectomy with a Billroth II gastrojejunostomy one and a half years previously, complained of recent severe weakness as the only symptom was found to have an iron deficiency anemia with a periumbilical mass. A gastrointestinal series showed a soft tissue density in the epigastric area which, by ultrasonography, was found to be fluid-containing. Laparotomy revealed obstruction of the afferent loop caused by a marginal ulcer.