Afferent loop syndrome

Afferent loop syndrome

    * Introduction
    * Symptoms and Diagnosis
    * Treatment
Afferent loop syndrome is an infrequent complication that occurs after a mechanical gastrojejunostomie. Creating an anastomosis between the stomach and jejunum leave a segment of small intestine, the duodenum and jejunum proximal common, besides the continuity of the bowel. The rest retain intestinal bile, pancreatic secretions and intestinal secretions proximal gastrojejunostoma other, related to him as a loop.
Afferent loop syndrome is a complication of Billroth II surgical procedure and occurs in 0. 3% of cases.
Clinical manifestations are due to intestinal obstruction by accumulation of digestive secretions, adhesions, internal hernia, stenosis, gastric malignancy or inflammation of the anastomosis. Loop obstruction associated with the accumulation of pancreatic secretions, intestinal and biliary dilatation determine it. The pressure can cause bladder dilatation, dilatation of the gallbladder and acute pancreatitis.
Clinical manifestations include varied and nonspecific, depending on whether chronic or acute obstruction. They are: abdominal pain, nausea and vomiting, postprandial bloating and early satiety sensation rarely postobstructiv jaundice.
In patients with acute syndrome, a favorable evolution is associated with rapid diagnosis and corrective surgery. Medical therapy does not have any role.
Syndrome, may be in a state of chronic malnutrition and severe anemia. They may benefit from nutritional support preoperativ or transfusion before surgery.
The mortality rate is 57% for acute afferent loop syndrome unresolved in time. Mortality is frequently associated with delayed diagnosis leading to intestinal infarction, rupture and peritonitis. Patients who have been diagnosed in time and shows signs of chronic obstruction can be operated with acceptable rates of mortality and mobiditatii.
Pathogenesis
Gastrojejunostomia Billroth II-type is performed in peptic ulcer or gastric malignancy with reconstruction, and jejunostomie pancreatoduodenectomie bypass performed for other pathology in the bowel. Pathology and clinical manifestations result from complete or total obstruction of the loop related. Afferent loop syndrome is included in the complications of gastric resection surgery, known as postgastrectomie syndromes.
These include: Dumping syndrome, early, late Postvagotomie-diarrhea, chronic gastric atony Roux-stasis syndrome, the syndrome of incomplete emptying -Alkaline reflux gastritis, afferent loop syndrome -Efferent loop syndrome.
A loop consists dintrun otherwise related ulcer, and one located proximal jejunal gastrojejunostomie. The syndrome is caused by partial obstruction or gastrojejunostomie mechanics at another point along the jejunal loop portion thereof. The passage of food and gastric secretions by gastrojejunostomie and efferent loop determine the secretion of secretin and cholecystokinin. These enteric hormones stimulate the secretion of bile, pancreatic enzymes, bicarbonate and water afferent loop. Under the influence of gastrointestinal hormones in afferent loop secretions can accumulate up to 1 L daily.
Symptoms are caused by increased intraluminal pressure and distension. Afferent loop syndrome is one of the leading causes of obstructive jaundice, pancreatitis and post-operative colangitei transmission due to increased pressure in biliopancreatic tree. Increased luminal pressure and distention of the affected bowel wall leading to gangrene and perforation with peritonitis secondary loop.
Prolonged stasis encourages bacterial overpopulation chance. Bacteria deconjugheaza bile acids, leading to steatorrhea, malnutrition and vitamin B12. Iron deficiency can occur due to by-pass directly into the small intestine's.
Causes
Conditions that may cause post-operative afferent loop syndrome in a patient with gastrojejunostomie are: Encapsulation and compression-related loop by those application post-operative Internal hernia defect-mezocolic printrun A segment-gut volvulus Enteroenterala or enterogastrica-intussusceptia Ulceration of the wound edges, stoma, anastomotic cancer Enteroliti formation in ansa-related Inodarea loop-related -Foreign bodies in the loop or anastomosis.
Surgical techniques that predispose afferent loop syndrome include: The jejunal loop-related segment is longer than 10-15 cm Gastrojejunostomei-placing in position instead of retrocolica antecolica Mezocolice-defects were not closed properly after building a retrocolice gastrojejunostomii