The loop going to the upper stomach is the afferent loop. Hepatobiliary scintigraphy is a radionuclide diagnostic imaging study including planar imaging, spect, or hybrid imaging such as spectct that evaluates hepatocellular function and the biliary system by tracing the production and flow of bile from the formative phase in the liver, and its passage through the biliary system into the small intestine. Afferent loop syndrome definition, symptoms, causes. Afferent loop syndrome after gastrectomy is an uncommon complication of gastroenterostomy reconstruction. A 51yearold japanese man underwent pancreaticoduodenectomy for carcinoma of the. Afferent loop syndrome radiology reference article. Endoscopic ultrasoundguided enteroenterostomy for the. Afferent loop syndrome, multidetectorrow ct, rouxeny.
Endoscopic management of afferent loop syndrome eventscribe. Statistical analysis was performed with commercial software graphpad. The clear differentiation between the afferentloop syndrome als and the other postgastrectomy syndromes was made by hoffmann 3. In this study, a less invasive technique was described for treatment of benign afferent loop obstruction. What is the role of imaging studies in the workup of. Afferent loop syndrome als is traditionally managed surgically and, more recently, endoscopically. In a loop syndrome, part of the small intestine becomes blocked. The practice guidelines recognize that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Ascending cholangitis caused by afferent loop syndrome is a potential, but rare, complication patient concerns. Afferent loop syndrome als is an infrequent mechanical complication that occurs after reconstruction of billrothii bii gastrojejunostomy or rouxeny esophagojejunostomy. Afferent loop syndrome is an intermittent partial or complete mechanical obstruction of the afferent limb of a gastrojejunostomy.
Usually a problem is a kink or twist where the afferent limb attaches to the gastric remnant, but the obstruction can, in theory, be anywhere along the limb. Creation of an anastomosis between the stomach and jejunum leaves a segment of small bowel, most commonly consisting of duodenum and proximal jejunum, lying upstream from the gastrojejunostomy. Afferent loop obstruction following pancreaticoduodenectomy pd is a rare complication. Endoscopic nasogastric tube insertion for treatment of benig. Afferent system definition of afferent system by the. Afferent loop syndrome is a rare complication of gastric surgery. Pdf on may 1, 2007, sabri yilmaz and others published afferent loop syndrome secondary to billroth ii gastrojejunostomy obstruction. He had a history of total gastrectomy with a rouxeny reconstruction. Acute als results from complete obstruction, usually occurs early after surgery and runs a devastatingly lethal course unless promptly treated by reoperation. This symptomcomplex has been termed the afferent loop syndrome. Malignant afferent loop obstruction following pd presents a particular therapeutic challenge because the postsurgical anatomy usually prevents an endoscopic approach 2, 5. Using multidetectorrow ct for the diagnosis of afferent. Afferent loop syndrome definition of afferent loop. An obstruction of the afferent limb can present in various ways.
Treatment most often starts with antibiotics for the excess bacteria. Afferent loop syndrome synonyms, afferent loop syndrome. Selfexpanding metal stent procedure for afferent loop. Causes include jejunal herniation, intussusception, kinking, volvulus, marginal ulceration, paraanastomotic stenosis, and adhesion formation.
The term afferent limb syndrome is used to describe the chronic, partially obstructed situation. Selfexpanding metal stent placement is a useful procedure for intestinal obstruction. Acute biliopancreatic limb obstruction has typical ct features. The patient, an airline worker in her 50s, presented with a 3day history of cough, fever and altered mental status. Afferent loop syndrome is caused by a partial or complete obstruction on the area where the surgery was done or along the jejunal region of the afferent loop. In a postop whipple patient, an acute afferent limb obstruction is especially concerning because theres a fresh bilary anastomosis potentially at. A problem with an anastomosis after gastrojejunostomy, such as an ulcer. Using multidetectorrow ct for the diagnosis of afferent loop. T the afferent loop syndrome is a complication of partial gastric resection, in which intes tinal continuity has been restored by gastro jejunostomy. Percutaneous cholangioscopic lithotripsy for afferent loop.
Afferent loop syndrome treated by endoscopic ultrasound. The clear differentiation between the afferent loop syndrome als and the other postgastrectomy syndromes was made by hoffmann 3, who described the clinical picture as follows. From january 2004 to december 2008, 1,100 patients had undergone gastroenterostomy. Carrying inward to a central organ or section, as nerves that conduct impulses from the periphery of the body to the brain or spinal cord. A 73yearold man presented with one day of persistent abdominal pain, gradually radiating to the back. The efferentloop syndrome in a narrow sense refers only to obstruction of the efferent jejunal loop after gastric resection or simple gastroenterostomy. Blind loop syndrome occurs when digested food slows or stops moving. March 31, 2020 a brief article from henry ford health system in detroit, published today in radiology, reports on the first presumptive case of covid19associated acute necrotizing hemorrhagic encephalopathy. Afferent loop syndrome complicated by a duodenal phytobezoar after billrothii. Afferent limb syndrome also called afferent loop syndrome is a complication following billroth ii gastrojejunostomy characterized by acute or chronic intermittent obstruction of the afferent jejunal limb. Ascending cholangitis caused by afferent loop syndrome is a potential, but rare, complication.
Afferent system synonyms, afferent system pronunciation, afferent system translation, english dictionary definition of afferent system. Surgeons have improved gastric surgery, so both types of. Afferent loop syndrome radiology reference article radiopaedia. The loop carrying food away from the stomach is called the efferent loop. A 73yearold man with abdominal pain and vomiting was admitted to the emergency room. The probable cause of the syndrome was predicted on the basis of sonography in two of three patients with cancer at the anastomosis. Imaging studies may be of greater utility in patients with chronic als in which the diagnosis is often elusive. Efferent loop syndrome health encyclopedia university. Whipple procedures are mainly used to treat patients with pancreatic head and periampullary tumors as well as for those with chronic pain syndrome. To assess the clinical manifestations and multidetectorrow computed tomography mdct findings of afferent loop syndrome als and to determine the role of mdct on treatment decisions. Afferent loop syndrome health encyclopedia university. Bile and pancreatic juice accumulate in the afferent limb until the pressure in the limb is sufficient to overcome the partial obstruction. Causes include jejunal herniation, intussusception, kinking, volvulus, marginal ulceration, paraanastomotic.
Afferent loop syndrome after whipple procedure sages. Effective and safe therapeutic strategies for malignant afferent loop obstruction following pancreaticoduodenectomy are scarce at present. Aspiration from the distended proximal limb yields a high bacterial count, with gramnegative organisms predominating and resembling colonic flora in both quantity and quality 5, 6. Afferent loop sydrome common after bilroth ii is characterized by post prandial ruq pain, bilious vomiting, anemia, steatorrhea, and pain which resolves suddenly after decompression. Afferent nerve fibers refer to axonal projections that arrive at a particular brain region, as opposed to efferent projections that exit the region. Percutaneous transhepatic metallic stent insertion for. The efferent loop syndrome in a narrow sense refers only to obstruction of the efferent jejunal loop after gastric resection or simple gastroenterostomy. The other type of loop syndrome is afferent loop syndrome. After a surgical procedure, the pancreatic and bile juices get into the afferent loop. Small intestinal bacterial overgrowth sibo symptoms and causes. Afferent loop syndrome is a mechanical bowel obstruction internal hernia, volvulus, stricturing, etc that results in an effective biliary outlet obstruction. From the department of surgery, university of florida college of medicine, gainesville, florida university of florida college of medicine, gainesville, florida 32603 the pathophysiology of afferent loop syndrome e. Egd confirmed recurrence of tumor at gj anastomosis and.
Afferent loop syndrome als is caused by mechanical obstruction of the afferent loop of a doublebarrel gastrojejunostomy a. Afferent loop syndrome after rouxeny total gastrectomy. However, the edematous afferent loop may result in anastomotic fistula. Afferent loop syndrome is a problem that can occur after some kinds of stomach surgery. Comments should be on the topic and should not be abusive. It is similar to the blindloop syndrome seen with sidetoside intestinal anastomosis 4.
Jul 01, 2011 to assess the clinical manifestations and multidetectorrow computed tomography mdct findings of afferent loop syndrome als and to determine the role of mdct on treatment decisions. Afferent loop syndrome health encyclopedia university of. Afferent loop syndrome is a rare entity that may be the cause of abdominal pain, nausea and vomiting in patients who have had a gastrojejunostomy and is diagnosed primarily by clinical suspicion. It is similar to the blind loop syndrome seen with sidetoside intestinal anastomosis 4. Magnetic resonance cholangiopancreatography is a useful imaging modality to understand and visualise the pancreaticobiliary anatomy and abnormalities. A marcus gunn pupil, also known as a relative afferent pupillary defect rapd, is a nonspecific sign on physical examination that indicates partial optic nerve dysfunction. Our objective was to report the ct features of biliopancreatic limb afferent loop obstruction. In the following decades several authors were able clearly to demonstrate that bile reflux into the stomach causes vomiting. Statistical analyses were performed using statistical software spss. Cancer that blocks the afferent loop afferent loop syndrome can occur anywhere from days to years after surgery.
Afferent loop syndrome definition of afferent loop syndrome. Blind loop syndrome uf health, university of florida health. Snm practice guideline for hepatobiliary scintigraphy 4. A patient had afferent loop obstruction with primary carcinoma of the gastric remnant and nonjaundiced biliary obstruction. Creation of an anastomosis between the stomach and jejunum leaves a segment of the small bowel, most commonly consisting of the duodenum and proximal jejunum, lying upstream from the gastrojejunostomy. The role of endoscopic ultrasoundguided enteroenterostomy eusee has not been. This symptomcomplex has been termed the afferentloop syndrome. Jul 16, 2012 malignant afferent loop obstruction following pancreaticoduodenectomy is a rare complication and may be fatal if suppurative cholangitis or obstructive jaundice develops. Abstractafferent loop obstruction caused by enterolith formation is rare and cannot be easily treated with. In a postop whipple patient, an acute afferent limb obstruction is especially concerning because theres a fresh bilary anastomosis potentially at risk. Abdominal computed tomography scan revealed dilation of the duodenum and small intestine.
These terms have a slightly different meaning in the context of the peripheral nervous system pns and central nervous system cns in the pns, afferent and efferent projections are always from the perspective of the spinal cord see figures. Pdf afferent loop syndrome secondary to billroth ii. Afferent loop syndrome als is a purely mechanical complication that infrequently occurs following the construction of a gastrojejunostomy. Efferent loop syndrome health encyclopedia university of. Afferent loop syndrome is an intermittent partial or complete mechanical obstruction of the afferent limb of a gastrojejunostomy the syndrome classically refers to obstruction of the upstream limb of a sidetoside gastrojejunostomy but has also been used to refer to the biliopancreatic limb of a rouxeny gastrojejunostomy. A 73yearold man with abdominal pain and vomiting was admitted to the. Efferent loop syndrome is one of two loop syndromes that can happen after some types of gastric surgery. Synonyms for afferent loop syndrome in free thesaurus. The pathophysiology of afferent loop syndrome sciencedirect. Ct scan also showed obstruction of the afferent limb which was markedly dilated.
The aim of this study was to investigate the effectiveness and safety of endoscopic nasogastric tube insertion for treatment of benign afferent loop obstruction. Afferent loop syndrome after subtotal gastrectomy with. Using multidetectorrow ct for the diagnosis of afferent loop syndrome following gastroenterostomy reconstruction yuhsiu juan, 1, 2 chihyung yu, 1 hsianhe hsu, 1 guoshu huang, 1 dechuan chan, 3 changhsien liu, 1 hojui tung, 4 and weichou chang 1. Afferent loop syndrome after subtotal gastrectomy with billrothii. This condition is sometimes called blind loop syndrome. Endoscopic nasogastric tube insertion for treatment of. Radiology publishes first case of covid19 encephalopathy. Afferent loop sydrome common after bilroth ii is characterized by post prandial ruq pain, bilious vomiting, anemia, steatorrhea, and pain which resolve. Twisting of the afferent loop scar tissue near the afferent loop after surgery. This article is from clinical endoscopy, volume 46. The afferent loop syndromes result from obstruction to the afferent jejunal loop. Afferent loop syndrome als is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. Learn more information about afferent loop syndrome.
Als may be surgically corrected by deconstructing the billroth ii gastrojejunostomy and restoring gastrointestinal continuity with a rouxeny gastrojejunostomy b. Professor and department chairman professor and department chairman references 1. May 15, 2019 afferent loop syndrome als is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. Multidetector computed tomography findings find, read and. Jan 17, 2010 post billroth ii obstruction of afferent loop by adhesions, ulcer, tumor, internal herniation distension, pain, nausea nonfilling of dilated, fluidfilled afferent limb on ct perforate, peritonitis. Most cases of afferent loop obstruction following pd are malignant and may be fatal if cholangitis or jaundice develops 14. Our experience suggests that afferent loop syndrome can be diagnosed sonographically on the basis of the detection, location, and shape of the dilated afferent loop.
Dec 28, 2008 afferent loop syndrome is a mechanical bowel obstruction internal hernia, volvulus, stricturing, etc that results in an effective biliary outlet obstruction. Selfexpanding metal stent procedure for afferent loop syndr. Blind loop syndrome bls, also known as stagnant loop syndrome, is a state that occurs when the normal bacterial flora of the small intestine proliferates to numbers that cause significant derangement to the normal physiological processes of digestion and absorption. For acute afferent loop syndrome, emergency surgery may be needed. Afferent definition of afferent by medical dictionary.
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