Afferent loop syndrome

Fig.4.7a,b. Afferent loop syndrome, a Supine abdominal radiograph shows virtually absent bowel gas because of frequent vomiting, b Sagittal color Doppler sonogram of the upper abdomen shows the dilated third part of the duodenum (D3) anterior to the abdominal aorta and posterior to the superior mesenteric artery (arrows)... 

Lee DH, Lim JH, Ko YT (1991) Afferent loop syndrome sonographic findings in seven cases. Am J Rogentgenol 157 41-... 

Afferent loop syndrome (ALS), caused by obstruction of the duodenum and jejunum proximal to a... 

Fig. 9.25a,b. Afferent loop syndrome, a CECT of the upper abdomen shows a markedly distended fluid-filled tubular structure with identifiable valvulae conniventes compatible with a dilated afferent loop. Note the dilated intrahepatic bile ducts, b A more caudal image demonstrates that the dilated afferent loop is obstructed by a recurrent tumoral mass at the level of the horizontal part of the duodenum... 

Gayer G, Barsuk D, Hertz M et al (2002) CT diagnosis of afferent loop syndrome. Clin Radiol 57 835-839... 

Williams SC, Peller PJ (1994) Gardner s syndrome. Case report and discussion of the manifestations of the disorder. Clin Nuc Med 19 668-670 Wise SW (2000) Case 24 afferent loop syndrome. Radiology 216 142-145... 

Breakdown of suture lines and leakage are a common complication of the early postoperative phase. Afferent loop syndrome is a specific problem of Billroth II procedures and is caused by mechanical obstruction usually from adhesions. Internal hernias, extrinsic compression, bowel stenosis may also occur. Bezoar formation in the gastric remnant, anastomotic ulcers, incisional hernia of the abdominal wall and hiatal hernia are all also potential complications. Stenosis of the gastrojejunostomy after Billroth II procedures leads to obstruction (Fig. 13.14). Fistula after Billroth II is rare (Fig. 13.15). Tumour of the gastric renmant can be due to recurrence or present as a primary carcinoma of the stump (Fig. 13.16). 

The significant disturbances in physiology consequent on this procedure (dumping syndromes, afferent and efferent loop syndromes) were thought tolerable as compared to the invariable mortality associated with a leak from a Billroth l-type anastomosis. 

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