Carolinas Research Day 2021

Clinical Case-Based Studies

08 Small Bowel Obstruction Secondary to Afferent Loop Syndrome

Malka Fox-Epstein, OMSIII, Michael Hill, MD

Regional Medical Center, Orangeburg, SC

Abstract: Afferent loop syndrome is a rare complication that can occur after various upper gastrointestinal procedures involving anastomosis of the stomach to the jejunum. Up to 1% of patients who undergo partial gastrectomy with Billroth II or Roux-en-Y reconstruction will experience afferent loop syndrome [1]. Although the majority of afferent loop syndromes present in the early postoperative period, there are accounts of chronic afferent loop syndrome presenting years after gastrectomy [2]. This case report describes a 53-year-old-male with a prior Billroth II anastomoses 10 years ago, who

presented with severe abdominal pain and rectal bleeding associated with nausea and bilious vomiting. A CT of the abdomen and pelvis revealed a vastly dilated fluid filled proximal small bowel and markedly distended stomach, consistent with a closed loop obstruction. Intraoperatively, the patient underwent an esophagogastroduodenoscopy that showed a stricture at the anastomosis and reconstruction with a Roux-Y anastomosis was performed immediately. The patient had an uneventful postoperative course and recovered well.

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