A Case of Afferent Loop Syndrome after Total Gastrectomy caused by Obstruction of Jejuno-Jejunostomy of Roux-Y Loop using Stapling Anastomotic Technique

Hirofumi Suwa¹⁾⁵⁾, Nobuo Baba¹⁾, Masahiko Kondo²⁾, Hisato Kobayashi³⁾, Tatsuyoshi Saiga⁴⁾, Hideaki Ohe¹⁾, Akira Yoshikawa¹⁾, Shunichi Ishigami¹⁾, Jun Tamura¹⁾ and Shiro Sakanashi¹⁾

Department of Surgery¹⁾, Department of Gastroenterology²⁾, Department of Radiology³⁾ and Department of Pathology⁴⁾, Otsu Red Cross Hospital
Department of Surgery, Hyogo Prefectural Tsukaguchi Hospital⁵⁾

The patient was a 50-year-old man with the chief complaints of abdominal distention and general malaise nine months after total gastrectomy with a Roux-Y reconstruction for gastric cancer. Abdominal computed tomography and ultrasonography revealed marked dilatation of the afferent loop, and the patient was diagnosed as having afferent loop syndrome. The stoma of the jejuno-jejunostomy, which had been reconstructed by the stapling technique at the time of total gastrectomy could not be identified by upper gastrointestinal endoscopy using a scope equipped with a lucid cap. Therefore, dilatation of the anastomotic stricture could not be carried out using an endoscopic procedure. Exploratory laparotomy under general anesthesia revealed an obstruction of the jejuno-jejunostomy. We resected the obstructed anastomotic portion, and reconstructed the jejuno-jejunostomy. Histopathological examination revealed that the obstruction had been caused by extension of mucosa and muscular layer. It is thought that further modification is needed to improve the stapling technique during formation of the Roux-Y loop. In patients presenting with abdominal distention after total gastrectomy and Roux-Y reconstruction, it is necessary to keep in mind this rare complication, as early recognition of dilatation of the afferent loop is important.

Key words
total gastrectomy, stapling technique, afferent loop syndrome

Reprint requests
Hirofumi Suwa Department of Surgery, Hyogo Prefectural Tsukaguchi Hospital
6-8-17 Minami-tsukaguchi-cho, Amagasaki, 661-0012 JAPAN

Accepted
December 15, 2006

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