[The acute syndrome of the afferent loop].
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Dumping Syndrome↗
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Percutaneous jejunostomy and stent placement for treatment of malignant Roux-en-Y obstruction: a case report.
Nineteen months after a Whipple procedure for pancreatic carcinoma, a 79-year-old woman developed recurrent tumoral strictures of the bile ducts and afferent Roux-en-Y limb with resultant jaundice, cholangitis, and liver abscess. Transhepatic abscess and biliary drainages were performed first. Afferent loop obstruction was too far from biliary anastomosis to be crossed via the transhepatic route. Percutaneous jejunostomy and stenting were performed to relieve the malignant afferent loop syndrome. After initial relief of symptoms, jaundice recurred in relation to peritoneal carcinomatosis progression and was treated with percutaneous jejunostomy drainage until patient's death. Therapeutic options of tumoral occlusion of afferent loops are reviewed.
Aged↗
[The radiological study of afferent and efferent loop syndromes].
The authors report on the diagnostic role of radiological imaging in the study of the patients who underwent gastric surgery. This kind of intervention is often followed by postoperative complications, so that accurate clinical-instrumental investigations are required. Routine controls both in the immediate postoperative period and during follow-up are useful especially when a neoplastic lesion was the underlying condition leading to surgery. Radiological imaging plays a fundamental role especially in evaluating such postoperative conditions as afferent and efferent loop syndromes. Radiology is thought to be essential to demonstrate the syndrome and to identify the mechanical/functional nature of the factors causing the disease, all of which are essential to an appropriate and safe therapy. Both the duration of follow-up (early and late controls) and the choice of contrast (water-soluble contrast medium or double contrast enema) are very important factors depending on the time of surgery and the clinical indication.
Afferent Loop Syndrome↗
[Peptic anastomotic ulcer induced by continuous duodenogastrix reflux (author's transl)].
Different types of duodenal by-pass operations with and without duodenogastric reflux were performed on 54 male Wistar rats. The results of our investigation show that following duodenal by-pass with reflux peptic anastomotic ulcer regularly occurs. The constant reflux of bile and pancreas juice is the most important aetiologic factor in the development of ulcer in the vicinity of the anastomosis between the stomach and small intestine. Stasis in the by-passed duodenum (afferent loop syndrome) promotes ulcerogenic action of reflux. In the absence of the pylorus the effects of reflux ans stasis potentiate, resulting in a high frequency of ulcer (greater than 90%). With intact pylorus the incidence is low. Duodenogastric reflux prevents hydrochloric acid secretion significantly (P less than 0.01); hydrochloric acid thus plays a minor role in the development of experimental anastomotic ulcer of the rat. -In considering the prophylaxis against anastomotic ulcer, there findings support the claim of avoiding surgical techniques involving duodenal by-pass and reflux (Billroth II with short loop GE). Gastric resection should, therefore, aim at the reconstruction of the orthograde peristalsis.
Animals↗
A surgical technic for high (cardial or juxtacardial) benign chronic gastric ulcer.
A surgical technic for cardial or juxtacardial ulcers is presented. The surgical principle consists of resection of the distal stomach including the ulcer in a way that the esophageal mucosa remains intact. Reconstruction of the transit is accomplished by a Roux-en-Y esophagogastrojejunostomy in one layer. A variable portion of gastric reservoir is preserved, and alkaline reflux is highly improbable due to the long intestinal loop. This technic has been performed in six patients with excellent postoperative results. Clinical and radiologic follow-up to three years has shown no esophagitis or strictures of afferent loop syndrome.
Cardia↗
The postoperative stomach.
Gastric surgery may be performed for the treatment of a variety of benign and malignant diseases of the upper gastrointestinal tract, including peptic ulcers and gastric carcinoma. Radiographic studies with water-soluble contrast agents often are obtained to rule out leaks, obstruction, or other acute complications during the early postoperative period. Barium studies may also be obtained to evaluate for anastomotic strictures or ulcers, bile reflux gastritis, recurrent tumor, or other chronic complications during the late postoperative period. Cross-sectional imaging studies such as CT are also helpful for detecting abscesses or other postoperative collections, recurrent or metastatic tumor, or less common complications such as afferent loop syndrome or gastrojejunal intussusception. It is important for radiologists to be familiar not only with the radiographic findings associated with these various abnormalities but also with the normal appearances of the postoperative stomach on radiographic examinations, so that such appearances are not mistaken for pseudoleaks or other postoperative complications. The purpose of this article is to describe the normal postsurgical anatomy after the most commonly performed operations (including partial gastrectomy, esophagogastrectomy and gastric pull-through, and total gastrectomy and esophagojejunostomy) and to review the acute and chronic complications, normal postoperative findings, and major abnormalities detected on radiographic examinations in these patients.
Barium Sulfate↗
Gastroduodenostomy after gastric resection for cancer.
Gastrojejunostomy after resection for gastric cancer has been associated with a variety of complications, including bile reflux gastritis, marginal ulcers, and afferent loop syndrome. Gastroduodenostomy, although more physiologic, has not been recommended because of the fear of obstruction due to tumor recurrence. A review of 62 patients with gastric adenocarcinoma who underwent gastric resection from 1986 to 1996 was performed. Of the 62 patients, 52 (83%) underwent subtotal gastric resection and 10 (17%) underwent total gastrectomy with Roux-en-Y reconstruction due to tumor location. Forty-seven (90%) of the 52 patients underwent gastroduodenostomy, and 5 (10%) of these patients underwent gastrojejunostomy due to operative findings of excessive tumor burden or the inability to create a safe tension-free anastomosis. Patients who underwent gastroduodenostomies were followed for a period of 6 months to 5 years and had a median survival of 2.5 years. Two (4.2%) of the 47 patients obstructed due to tumor recurrence at 2 and 4 years postoperatively. One patient (2%) had symptomatic bile reflux gastritis, which was treated conservatively without reoperation. There were no incidences of marginal ulcers. In conclusion, gastroduodenostomy should be considered for patients undergoing resection for gastric cancer due to its physiological benefits and acceptable rate of obstruction.
Adenocarcinoma↗
[The indications for the use and the technical characteristics of gastric resection by Roux's method].
Based on findings of general diagnosis in 62 patients the authors have determined indications for using Roux resection of the stomach which was used as primary operation in 22 patients and repeated operation--in 40 patients. Main indications for Roux resection were chronic disturbance of duodenal patency, chronic pancreatitis, afferent loop syndrome, reflux-gastritis. The work describes technical peculiarities of the Roux resection of the stomach with necessary observation of 6 pathogenetically substantiated rules. Results of Roux resection of the stomach are good, no evacuatory disorders of the gastric stump were noted.
Adult↗
[Duodenogastric reflux and anastomosis abscess. Experimental study].
Different types of duodenal by-pass operations with and without duodenogastric reflux were performed on 54 male Wistar rats. The results of our investigation show that following duodenal by-pass with reflux peptic anastomotic ulcer regularly occurs. The constant reflux of bile and pancreas juice is the most important aetiologic factor in the development of ulcer in the vicinity of the anastomosis between the stomach and small intestine. Stasis in the by-passed duodenum (afferent loop syndrome) promotes ulcerogenic action of reflux. In the absence of the pylorus the effects of reflux and stasis potentiate, resulting in a high frequency of ulcer (greater than 90%). With intact pylorus the incidence is low. Duodenogastric reflux prevents hydrochloric acid secretion significantly (p less than o,o1); hydrochloric acid thus plays a minor role in the development of experimental anastomotic ulcer of the rat. -- In considering the prophylaxis against anastomotic ulcer, these findings support the claim of avoiding surgical techniques involving duodenal by-pass and reflux (Billroth II with short loop GE). Gastric resection should, therefore, aim at the reconstruction of the orthograde peristalsis.
Abscess↗
Severe pancreatico-duodenal injuries: the effectiveness of pyloric exclusion with vagotomy.
The operative management and clinical course of 17 patients treated for severe pancreatico-duodenal injuries from 1983 to 1990 was reviewed. The etiology of these injuries was gunshot wound in 15 patients; stab wound in 1 patient; and a motor vehicle accident in 1 patient. Seven patients presented in shock with a systolic blood pressure of less than 80. At exploration, 57 associated injuries were found in the 17 patients including 16 major vascular injuries. All patients were treated with pyloric exclusion and drainage. Vagotomy was performed in eight patients. None of these 17 patients were felt to have extensive enough damage to require pancreatico-duodenectomy. Two patients died in the immediate postoperative period of severe coagulopathy and two patients died of sepsis. Seven patients had complications related to the pancreatico-duodenal injury. All seven developed pancreatic fistulas; three also had pancreatitis and two developed multiple enterocutaneous fistulas. Systemic complications included pulmonary complications in eight patients and sepsis in five patients, including two patients with abdominal abscesses. Six patients bled in the immediate postoperative period secondary to coagulopathy. Three patients had complications related to pyloric exclusion. One developed afferent loop syndrome necessitating reoperation. The other two had marginal ulcers, which either perforated or bled and required reoperation. Of interest, neither of these two patients had vagotomy initially. The results of this series confirm the effectiveness of pyloric exclusion with vagotomy for severe pancreatico-duodenal injury.
Adolescent↗
Current status of small-bowel ultrasound.
Ultrasonography offers direct imaging of the bowel wall and allows dynamic evaluation of peristalsis. It helps to differentiate eosinophilic gastroenteritis from regional enteritis and lymphoma, displays a typical appearance in intussusception and is quite specific in the afferent loop syndrome, closed-loop obstruction and lymphedema. It may be helpful in ischemia of the bowel and in the evaluation of acute appendicitis.
Humans↗
[The prevention of postresection disorders in the surgical treatment of cancer of the distal stomach].
Four hundred and forty-seven patients who had undergone various surgical procedures for stage II-III cancer of the distal part of the stomach and 35 operated cases of chronic gastric ulcer were followed for three years. The study showed distal subtotal resection of the stomach using transversal gastroenteroanastomosis with a long loop and additional transversal enteroenteric anastomosis to offer functional advantage in cancer patients. These valve anastomoses prevented reflux of duodenal contents to the gastric stump, assured a stepwise emptying of the resected stomach and precluded passing of food to efferent intestine thus preventing dumping and afferent loop syndromes.
Anastomosis, Surgical↗
[Morphology of the pancreas in peptic ulcer and the complications of stomach resection].
Morphological examinations of 115 biopsies of the pancreas showed the peptic ulcer and postgastroresection complications not to be the leading factors in the etiology of the pancreatic pathology. Gastric resection does not favour the affection of the pancreas but may aggravate the existing morphological lesions. Despite the lack of crude histological changes in the pancreatic gland in peptic ulcer, ultrastructural signs of a high functional intensity of acinary cells were found which may also be regarded as pathological manifestations. Most marked changes of the histostructure of the pancreatic gland were found in peptic ulcer of the gastroenteroanastomosis. A difference in the A-cell content of pancreatic insulae before and after gastric resection was found. As the pancreatic tissue is frequently intact in the afferent loop syndrome, the leading role of duodenostasis in chronic affection of the pancreatic gland may be disputed.
Biopsy↗
Von Haberer-Finney gastrectomy revisited.
Von Haberer and Finney independently introduced end-to-side gastroduodenostomy for gastrointestinal reconstruction. Clinical appraisal of this procedure with hemigastrectomy is the basis of this report. From 1967 to 1982, 113 duodenal ulcer patients underwent the operation. Indications were intractability in 58 patients, hemorrhage in 36, perforation in two, and obstruction in 17. Truncal vagotomy was performed on all patients except in five with intractability, 19 with hemorrhage, two with perforation, and 17 with obstruction. There were three postoperative deaths (2.7%). Nine patients were lost to follow-up, seven of whom were operated upon 5 or more years previously. Thus far, there has been no clinical evidence of recurrent ulcers or of dumping. Five patients, all chronic alcoholics, were below normal weight. The Von Haberer-Finney gastrectomy has certain distinct advantages: 1) direct inspection of the interior of the descending duodenum is possible during duodenotomy; 2) anatomic continuity of the gastrointestinal tract is established; 3) duodenal stump perforation does not occur because the duodenum can be decompressed via a nasogastric tube passed through the anastomosis; 4) afferent loop syndrome cannot occur; and 5) iron deficiency anemia is less likely because the duodenum is not bypassed.
Adolescent↗
[Fracture of the collum of femur as a consequence of disturbed function in patients with resected stomach (Billroth II) (author's transl)].
Disturbed metabolism of bones like osteoporosis are not completely physiological in elder persons. In all cases it is needed to search for the origin. Under the intestinal factors is a slight calcium deficiency with food of a great importance for genesis of osteoporosis stimulating a occult secondary hyperparathyroidism. If vitamin D-deficiency is added a osteomalacic component is following called "Osteoporomalacia". This mixed form is typical for intestinals. Especially elder patients are endangered because the supplying of calcium and vitamin D also the calcium absorption are decreasing with getting elder. The calcium absorption is also smaller in patients with resected stomach (Billroth II). When the function in resected stomach is disturbed like in our case of afferent-loop-syndrome a osteoporosis with osteomalacic component and pathological fractures can develop. In such cases teamwork is worthwhile.
Aged↗
[The postoperative status of the gastroduodenum--clinical and endoscopic analysis of 2 years' of hospital data].
In 72 patients operated on for gastric ulcer, hospitalized at the Clinic of Gastroenterology and Hepatology in Novi Sad within two years (1989, 1990) we analyzed clinical disorders, biochemical status and endoscopic findings. 75% of the patients were males and 25% females, mean age being 49 years. In 70.83% the two-thirds Billroth II resection was performed, in 15.28% the two thirds Billroth I resection, in 9.72% truncal vagotomy with pyloroplasty, while in 4.17% supraselective vagotomy was carried out. The mean period of time after the operation was 12 years. The majority of patients complained about gastrointestinal disorders, and manifest hemorrhage was detected in 4.17% of the patients. The symptoms of the afferent loop syndrome and early dumping syndrome were verified in one patient from each group. The endoscopic finding was normal in only 2.78%, reflux esophagitis in 6.94%, chronic gastritis with and without erosions in 86.11%, chronic anastomositis in 69.44%, recurrent ulcer in 29.16% out of which hemorrhagic ulcer was found in 4.17%. Malignant neoplasm of the stomach stump was endoscopically evidenced and histologically proved in 2.78%. Multiple associated endoscopic changes were found in 58.33%. The analysis indicates the diversity of postoperative disorders after one of the operations on gastroduodenum, requiring postoperative follow ups of the patients with subjective discomfort, appropriately set diagnosis and individual therapeutical approach to prevent more serious complications.
Adult↗
The role of 99mtechnetium (Tc) diethyl-iminodiacetic acid (EHIDA) hepatobiliary scintigraphy in the diagnosis of a rare cause of obstructive jaundice.
This paper illustrates the role of 99m-Technetium(Tc) diethyl-iminodiacetic acid (EHIDA) hepatobiliary scintigraphy in a patient who developed obstructive jaundice as a result of afferent loop syndrome, which is a rare occurrence. The computed tomographic (CT) and ultrasonographic findings are also described.
Cholestasis↗
[The syndrome of the afferent loop].
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Digestive System Surgical Procedures↗