A CASE OF ACUTE AFFERENT LOOP NECROSIS AND PERFORATION FOLLOWING BILLROTH-II GASTRECTOMY

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  • HASEGAWA Makoto
    Department of Surgery, Teikyo University School of Medicine, Ichihara Hospital
  • NAGASHIMA Yoshitsugu
    Department of Surgery, Teikyo University School of Medicine, Ichihara Hospital
  • KOZAWA Kunihisa
    Department of Surgery, Teikyo University School of Medicine, Ichihara Hospital
  • WADA Nobuaki
    Department of Surgery, Teikyo University School of Medicine, Ichihara Hospital
  • NAGAO Koichi
    Department of Pathology, Teikyo University School of Medicine, Ichihara Hospital

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  • 胃切除(B-II法)術後8年の経過中,輸入脚に急性壊死穿孔を生じた1例

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Abstract

Acute afferent loop obstruction is rather rare complication after gastrectomy (Billroth-II). It is characterized by acute abdominal pain and high blood level of amylase. Demonstration of a dilated afferent loop by CT and abdominal ultrasonography is diagnostic. But it is often difficult to make the accurate diagnosis. Delayed diagnosis and surgical treatment result in necrosis and perforation of the afferent loop.<br> Recently we experienced a case of acute afferent loop necrosis and perforation 8 years after a gastrectomy.<br> A 51-year-old man complaining of severe epigastralgia was referred to the hospital because of intensified abdominal pain and development of sings of peritonitis. There were previous histories of undergoing a Billroth II gastrectomy for perforation of gastric ulcer 8 years before and adhesiolysis 7 years before. On admission leukocytopenia and high blood amylase level were recognized on blood analysis. Upper gastrointestinal X-ray examination (Gastrografin®) revealed a leakage of contrast media near the anastomosis. Then an emergency operation was performed. There were perforations on the third and forth portion of the duodenum. After trimming off the necrotic tissue around perforations, suture closure was performed. The patient was discharged very inproved on the 55th day after the operation.

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