Acute pancreatitis and afferent loop syndrome (ALS) have similar symptoms and physical findings. Accurate early diagnosis is essential, as the management of acute pancreatitis is predominantly conservative whereas ALS usually requires surgery. We experienced one case of pancreatitis due to ALS with internal hernia. Laboratory findings of patient showed elevated serum amylase, lipase and WBC count. One day after admission, diagnosis was modified as acute pancreatitis caused by ALS on computed tomography. Patient was managed with surgical treatment and operation finding revealed ALS due to internal hernia. He was recovered well after surgical treatment and discharged without significant sequelae.
Acute Disease ; Afferent Loop Syndrome/complications/*diagnosis/surgery ; Endoscopy, Gastrointestinal ; Gallstones ; Hernia, Abdominal/*complications ; Humans ; Male ; Middle Aged ; Pancreatitis/*diagnosis/etiology ; Radiography, Abdominal ; Tomography, X-Ray Computed

PURPOSE: To assess the clinical manifestations and multidetector-row computed tomography (MDCT) findings of afferent loop syndrome (ALS) and to determine the role of MDCT on treatment decisions. MATERIALS AND METHODS: From January 2004 to December 2008, 1,100 patients had undergone gastroenterostomy reconstruction in our institution. Of these, 22 (2%) patients were diagnosed as ALS after surgery that included Roux-en-Y gastroenterotomy (n=9), Billroth-II gastrojejunostomy (n=7), and Whipple's operation (n=6). Clinical manifestations and MDCT features of these patients were recorded and statistically analyzed. The presumed etiologies of obstruction shown on the MDCT were correlated with clinical information and confirmed by surgery or endoscopic biopsy. RESULTS: The most common clinical symptom was acute abdominal pain, presenting in 18 patients (82%). We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS. Malignant causes of ALS, such as local recurrence and carcinomatosis, are the most common etiologies of obstruction. These etiologies and associated complications can be predicted 100% by MDCT. CONCLUSION: Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.
Adult ; Afferent Loop Syndrome/*radiography ; Aged ; Aged, 80 and over ; Female ; Gastroenterostomy/*adverse effects ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed/*methods

Afferent loop syndrome is a rare complication which can occur in patients with Billroth II gastrectomy. Bile and pancreatic juice is congested at afferent loop in the syndrome. This syndrome can progress rapidly to necrosis, perforation, or severe sepsis, and therefore early diagnosis and swift surgical intervention is important. But, cases of endoscopic or percutaneous transhepatic drainage have been reported when surgical management was inappropriate to proceed. We report a case of afferent loop syndrome accompanying acute cholangitis developed after percutaneous transhepatic cholangioscopic lithotripsy for the retrieval of common bile duct stone in a patient who underwent Billroth II gastrectomy due to early gastric cancer. There was no other organic cause. We treated afferent loop syndrome successfully by performing balloon dilation of afferent loop outlet.
Acute Disease ; Afferent Loop Syndrome/*etiology ; Aged, 80 and over ; Balloon Dilation ; Cholangiography ; Cholangitis/*etiology ; Choledocholithiasis/*diagnosis/radiography/therapy ; Common Bile Duct ; Gallstones/*diagnosis/therapy ; Gastroenterostomy ; Humans ; Lithotripsy/*adverse effects ; Male ; Stomach Neoplasms/surgery ; Tomography, X-Ray Computed