Two Cases of Afferent Loop Obstruciton Due to Internal Hernia After Roux-en Y Reconstruction for Congenital Biliary Dilatation

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  • 胆道拡張症術後にイレウスで発症した輸入脚閉塞症の 2 例

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Abstract

Afferent loop obstruciton (ALO) is rare sequela of Billroth type II or Roux-Y reconstruciton after gastrectomy in adults. We describe two pediatric cases of ALO due to internal hernia after antecolic Roux-en Y (RY) reconstruction for congenital biliary dilatation. In one case, the afferent loop was proved to be necrotic at laparotomy. Therefore, the afferent loop was necessary to be totally resected and be reconstructed in retrocolic route. In the other case, severe necrosis was noticed in the middle of the afferent loop, which was required for partial resection with end-to-end anastomosis. In both cases, plain X-rays failed to reveal dilated bowel segment because of a lack of gas. Ultrasonography was useful to detect the dilated afferent loop with lots of fluids without gas and torsion of the intestine. In order to prevent ALO, (1) antecolic RY reconstruction with the Braun anastomosis and closing back space of the afferent loop, (2) closing space between afferent loop and the transverse mesenterium even if retrocolic RY reconstruction, (3) appropriate afferent loop length. And antecolic RY reconstruction should be avoided. ALO in biliary reconstruction is a serious complication with sudden onset and acute course. And it needs appropriate diagnosis and surgical measures. This sequela is rare in children, still it showed be kept in mind that this complication can occur after RY reconstruction in biliary surgery.

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