Afferent loop syndrome 7‐years post Roux‐en‐Y gastrojejunostomy: An often‐forgotten pancreatitis cause. A case report

Abstract

Key Clinical Message Afferent loop syndrome is a rare post‐operative complication following upper gastrointestinal bypass surgeries, usually occurring within the first two weeks post‐operation. This case report, however, outlines afferent loop syndrome almost a decade post‐surgery, which was managed conservatively. A 54‐year‐old woman presented with a few days' history of epigastric pain, vomiting, and constipation. She had undergone a sleeve gastrectomy and was converted to a Roux‐en‐Y gastrojejunostomy for weight loss 9 and 7 years ago, respectively. Serum lipase was elevated at 1410 IU/L. Computed tomography showed high‐grade proximal small bowel obstruction, involving the efferent and afferent loops of the Roux‐en‐Y gastric bypass. The patient was given intravenous rehydration, electrolyte replacement and had a nasogastric tube inserted. She was discharged on day 5 of admission without significant sequelae. Afferent limb syndrome should be considered in patients with altered upper gastrointestinal anatomy who present with pancreatitis, regardless of the time period post‐operatively. Future guidelines should further more outline the factors indicated for surgical versus conservative management.

Keywords

• Afferent loop syndrome
• bariatric surgery
• Billroth II gastrojejunostomy
• pancreatitis
• post‐operative complication
• Roux‐en‐Y gastrojejunostomy