<Case report>Afferent Loop Obstruction : A Case Report

Afferent loop obstruction is an unusual but serious complication following a Billroth-II gastroenterostomy. A 49-year-old man, who had undergone surgery for a peptic ulcer 11 years earlier, was hospitalized with nausea, vomiting, and abdominal pain. Acute pancreatitis was initially suspected with a presence of hyperamylasemia, solely due to the lack of awareness of afferent loop obstruction, but the administration of a protease inhibitor failed to improve his symptoms. The disease was diagnosed based on computed tomography (CT) findings. An emergency laparotomy revealed an internal hernia of the afferent limb into the retro-anastomotic space. After relief of the hernia, a jejuno-jejunostomy was performed. For the diagnosis and management of afferent loop obstruction, careful evaluation of the patient's past history, imaging modalities such as CT or ultrasound examination, and upper gastrointestinal endoscopy are required.