Clin Endosc.  2011 Sep;44(1):59-64.

Endoscopic Management of Afferent Loop Syndrome after a Pylorus Preserving Pancreatoduodenecotomy Presenting with Obstructive Jaundice and Ascending Cholangitis

• Kim JK
• Park CH
• Huh JH
• Park JY
• Park SW
• Song SY
• Chung J
• Bang S

Abstract

Afferent loop syndrome is a rare complication of gastrojejunostomy. Patients usually present with abdominal distention and bilious avomiting. Afferent loop syndrome in patients who have undergone a pylorus preserving pancreaticoduodenectomy can present with ascending cholangitis. This condition is related to a large volume of reflux through the biliary-enteric anastomosis and static materials with bacterial overgrowth in the afferent loop. Patients with afferent loop syndrome after pylorus preserving pancreaticoduodenectomy frequently cannot be confirmed as surgical candidates due to poor medical condition. In that situation, a non-surgical palliation should be considered. Herein, we report two patients with afferent loop syndrome presenting with obstructive jaundice and ascending cholangitis. The patients suffered from the recurrence of pancreatic cancer after pylorus preserving pancreaticoduodenectomy. The diagnosis of afferent loop syndrome was confirmed, and the patients were successfully treated by inserting an endoscopic metal stent using a colonoscopic endoscope.

Keyword

Afferent loop syndrome; Endoscopic treatment; Pylorus preserving pancreaticoduodenectomy; Obstructive jaundice

MeSH Terms

Afferent Loop Syndrome
Cholangitis
Endoscopes
Gastric Bypass
Humans
Jaundice, Obstructive
Pancreatic Neoplasms
Pancreaticoduodenectomy
Pylorus
Recurrence
Stents