The purpose of this article is to assess the technical feasibility, clinical effectiveness, and optimal route of dual stent placement for afferent loop syndrome. Afferent loop syndrome health encyclopedia university of. Afferent loop syndrome definition of afferent loop syndrome. Afferent loop syndrome is an intermittent partial or complete mechanical obstruction of the afferent limb of a gastrojejunostomy the syndrome classically refers to obstruction of the upstream limb of a sidetoside gastrojejunostomy but has also been used to refer to the biliopancreatic limb of a rouxeny gastrojejunostomy. Efferent loop syndrome health encyclopedia university.
Afferent loop syndrome is a rare entity that may be the cause of abdominal pain, nausea and vomiting in patients who have had a gastrojejunostomy and is diagnosed primarily by clinical suspicion. The key difference between afferent and efferent arterioles is, the afferent arterioles bring the impure blood to the glomerulus whereas the efferent arterioles take away the pure filtered blood back to the circulatory system. May 15, 2019 afferent loop syndrome als is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. Blind loop syndrome bls is a state that occurs when the normal bacterial flora of the small intestine proliferates to numbers that cause significant derangement to the normal physiological processes of digestion and absorption. Afferent loop syndrome is a rare complication that occurs in 0. Treatment by means of the placement of dual stents. Efferent limb of gastrojejunostomy obstruction by a whole okra phytobezoar. We present a patient who had early efferent loop obstruction after gastrectomy due to a retained drain. If a person had or is about to have this procedure, one must be aware that afferent syndrome can possibly occur after the stomach surgery.
All aimed at helping you enjoy life by being aware of how to care for your health. Efferent loop syndrome is one of two loop syndromes that can happen after some types of gastric. These terms have a slightly different meaning in the context of the peripheral nervous system pns and central nervous system cns in the pns, afferent and efferent projections are always from the perspective of the spinal cord see figures. Els can occur with reconstruction of the alimentary tract after a whipple procedure, billroth ii gastrectomy or rouxeny gastric bypass. The proximal jejunal loop was transected near the point of attachment on the lesser curvature of the stomach. During the procedure, a surgeon will remove or bypass the lower part of the stomach and attach the remaining upper part of the stomach to a loop of small intestine. Etiologi entrapment or compression of the afferent loop.
Afferent loop syndrome als is caused by mechanical obstruction of the afferent loop of a doublebarrel gastrojejunostomy a. A 73yearold man presented with one day of persistent abdominal pain, gradually radiating to the back. Afferent nerve fibers refer to axonal projections that arrive at a particular brain region, as opposed to efferent projections that exit the region. Get a printable copy pdf file of the complete article 541k, or click on a page image below to browse page by page. Difference between afferent and efferent compare the. An obstruction of the afferent limb can present in various ways.
Difference between afferent and efferent arterioles compare. Nonsurgical treatment for afferent loop syndrome in. Acute als represents complete obstruction of the afferent loop and is a. Afferent loop syndrome radiology reference article. Efferent loop syndrome health encyclopedia university of. Efferent loop obstruction is a rare entity and the usual causes in the early post operative period are anastomotic edema and kinking due to poor reconstruction.
Afferent loop syndrome health encyclopedia university. Afferent loop syndrome is a mechanical bowel obstruction internal hernia, volvulus, stricturing, etc that results in an effective biliary outlet obstruction. When efferent loop syndrome happens, it is usually within the first few weeks after gastric bypass surgery. Afferent loop syndrome treated by endoscopic ultrasound. Afferent loop syndrome after rouxeny total gastrectomy. Finally, the las 15 mm 10 mm was deployed, and balloon dilation of the stent figure 1. Afferent loop sydrome common after bilroth ii is characterized by post prandial ruq pain, bilious vomiting, anemia, steatorrhea, and pain which resolve. Request pdf ct diagnosis of afferent loop syndrome to report the computed tomography ct features of afferent loop syndrome which is often clinically. Endoscopic treatment of efferent loop syndrome with insertion. Efferent loop syndrome els is a rare complication defined as mechanical obstruction of the efferent enteric jejunal limb causing symptoms such as epigastric pain and massive bilious vomiting. Hyperperistalsis in the afferent loop may spread to the efferent loop and cause intestinal hurry.
Nov 07, 20 afferent loop syndrome is commonly reported, while efferent loop syndrome is very rarely reported. A roux limb may be formed in multiple different gastrointestinal surgeries, including bariatric surgery, e. Without pain, and usually in the morning after getting up or some time after. Key difference afferent vs efferent arterioles blood is supplied to the kidney via renal arteries. Efferent loop obstruction is a rare complication after gastrectomy and most literatures discuss on the commoner complication of afferent loop syndrome. Pdf efferent limb of gastrojejunostomy obstruction by a. Abdominal computed tomography scan revealed dilation of the duodenum and small intestine. The signs and symptomes of both loop syndromes may be similar and difficult to distinguish, and surgical treatment is usually required to correct these problems. Afferent loop syndrome after whipple procedure sages. Difference between afferent and efferent arterioles key.
Afferent loop syndrome als is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. Creation of an anastomosis between the stomach and jejunum leaves a segment of the small bowel, most commonly consisting of the duodenum and proximal jejunum, lying upstream from the gastrojejunostomy. Division of afferent and efferent loops of jejunum. Because of the small sample size of the two patients in that report, further studies were needed to analyze the preferred method of stent insertion, as well as the clinical effectiveness of dual stents used to treat afferent loop syndrome. Afferent loop syndrome can occur after some types of gastrojejunostomy. Afferent limb syndrome also called afferent loop syndrome is a complication following billroth ii gastrojejunostomy characterized by acute or chronic intermittent obstruction of the afferent jejunal limb. He had a history of total gastrectomy with a rouxeny reconstruction. Free fulltext pdf articles from hundreds of disciplines, all in one place nonsurgical treatment for afferent loop syndrome in recurrent gastric cancer complicated by peritoneal carcinomatosis.
The major cause of syndrome is an intestinal hernia. Afferent loop syndrome an overview sciencedirect topics. Full text is available as a scanned copy of the original print version. This revealed that an extensive resection of the stomach had been performed previously, and only a. Afferent limb syndromes have decreased in incidence with newer surgical techniques to decrease the size of the limb. Most cases of als are caused by obstruction from adhesions. Efferent loop syndrome is one of two loop syndromes that can happen after some types of gastric surgery.
The afferent pathway carries nerve impulses into the cns central nervous system from the pns and the efferent pathway carries nerve impulses from the cns to the pns peripheral nervous system. The key difference between afferent and efferent neuron is that the afferent neurons carry nerve impulses from the sensory organs to the central nervous system while the efferent neurons carry nerve impulses from the central nervous system to the muscles the nervous system is the director of all body activities. The interlobular artery is the first branch of the renal artery. During the procedure, a surgeon will remove or bypass the lower part of the stomach and attach the remaining upper part of the stomach to a loop of small. The treatment may involve medical therapy or surgery. Stay up to date with the latest health news and useful resources. Creation of an anastomosis between the stomach and jejunum leaves a segment of small bowel, most commonly consisting of duodenum and proximal jejunum, lying upstream from the gastrojejunostomy. Anastomotic stricture and ulcers, bowel adhesions, jejenogastric intussusception and anastomotic cancer may be a cause much later.
Pdf acute afferent loop obstruction treated by endoscopic. Efferent nerve fibers refer to axonal projections that exit a particular region. Loop syndrome batasan sindroma akibat obstruksi mekanik lengkap atau parsial pada titik di sepanjang bagian jejunum loop aferen atau eferen post gastrojejunostomy komplikasi murni mekanis akibat tindakan gastrojejunostomy yang jarang terjadi tanda dan gejala dari kedua komplikasi sulit dibedakan. Endoscopic treatment of efferent loop syndrome with. Know why a new medicine or treatment is prescribed, and how it will help you. The efferent fiber is a long process projecting far from the neurons body that carries nerve impulses away from the. In some cases of blind loop syndrome, overgrowth of pathogenic non commensal bacteria has also been noted. In a postop whipple patient, an acute afferent limb obstruction is especially concerning because theres a fresh bilary anastomosis potentially at risk. Sensory neurones receive an impulse that is generat. Links to pubmed are also available for selected references.
Gastric analysis did not yield free hydrochloric acid but did disclose the presence of bile, grade 1, on a grading basis of 1 to 4. Rapid transit dumping syndrome postvagotomy diarrhea. For example, an artery is an efferent vessel that carries blood away from the heart, and an efferent nerve carries impulses away from the central nervous system. Afferent loop syndrome treated by eusguided gastrojejunostomy endoscopy 2017. Afferent or efferent loop syndrome is a purely mechanical problem characterized by the obstruction of gastric emptying at or near the site of a gastrojejunostomy. Acute obstruction of afferent or efferent loop, following. The clear differentiation between the afferent loop syndrome als and the other postgastrectomy syndromes was made by hoffmann 3, who described the clinical picture as follows. Jan 17, 2016 what does afferent loop syndrome mean in english. In a loop syndrome, part of the small intestine becomes blocked. Kinked efferent loop guidewire inserted and blind loop at site of. Ct diagnosis of afferent loop syndrome request pdf. Endoscopic jejunojejunostomy by use of a lumenapposing.
Dec 07, 2017 an efferent arteriole is a part of the renal artery that carries filtered pure blood back to the circulatory system. The efferentloop syndrome in a narrow sense refers only to obstruction of the efferent jejunal loop after gastric resection or simple gastroenterostomy. Pdf afferent loop syndrome als is a rare complication of billrothii gastrojejunostomy. Rouxeny gastric bypass biliopancreatic diversion partial gastrectomy total gastrectomy partial pancreaticoduodenectomy whipple.
Pdf the purpose of this article is to assess the technical feasibility and clinical effectiveness of the placement of partially covered. These arteries are branching directly from the aorta. Carrying inward to a central organ or section, as nerves that conduct impulses from the periphery of the body to the brain or spinal cord. Signs and symptoms of these two complications may be similar and difficult to distinguish.
To be accurate, the afferent limb is not only the afferent limb in patients following a billroth ii reconstruction but also refers to the biliopancreatic limb in patients following a rouxeny reconstruction, in this. Endoscopic treatment of efferent loop syndrome with insertion of. Efferent loop syndrome in a postpancreatoduodenectomy. Slow transit gastric stasis alkaline gastritis roux stasis syndrome. These terms have a slightly different meaning in the context of the peripheral nervous system pns and central nervous system cns. Efferent loop syndrome is a rare post gastectomy syndrome, while afferent loop syndrome is more common. Surgeons have improved gastric surgery, so both types of loop syndromes are now less common. Afferent loop syndrome is a problem that can occur after some kinds of stomach surgery.
Its major functions include communication among the body parts and controlling. The distal end of this loop was anastomosed to the end of the. The various methods used to reestablish gastroenteric continuity after subtotal gastrectomy still do not totally obviate unpleasant complications and sequelae. Although balloon dilation andor stenting may be useful in special cases, the cornerstone of treatment for afferent loop obstruction in patients with curable cancer. Without pain, and usually in the morning after getting up or some time after meals bilestained vomiting occurs without any food contents. Afferent loop syndrome is a rare complication of gastric surgery. Difference between afferent and efferent arterioles. Complications such as obstruction or dysfunction of the efferent jejunal loop, dumping syndrome.
The efferent loop syndrome in a narrow sense refers only to obstruction of the efferent jejunal loop after gastric resection or simple gastroenterostomy. Afferent and efferent loop syndrome jejunal intussusception internal hernia. Endoscopic treatment of efferent loop syndrome with insertion of double pigtail stent. Afferent loop syndrome definition, symptoms, causes. Afferent loop syndrome is not an uncommon postoperative complication, and one study has estimated that it occurs in % of postpancreaticoduodenectomy patients 2. Delay in emptying the afferent loop causes inadequate mixing of the duo denal contents and food. Afferent loop syndrome definition of afferent loop. Causes include jejunal herniation, intussusception, kinking, volvulus, marginal ulceration, paraanastomotic stenosis, and adhesion formation. Surgeons have improved gastric surgery, so both types of. Causes include jejunal herniation, intussusception, kinking, volvulus, marginal ulceration, paraanastomotic stenosis, and adhesion.
Afferent loop syndrome als is a purely mechanical complication that infrequently occurs following the construction of a gastrojejunostomy. Afferent loop syndrome which is also known as afferent limb syndrome is a complication caused by a stomach surgery specifically following billroth ii gastrectomy procedure. Als may be surgically corrected by deconstructing the billroth ii gastrojejunostomy and restoring gastrointestinal continuity with a rouxeny gastrojejunostomy b. Whipple procedures are mainly used to treat patients with pancreatic head and periampullary tumors as well as for those with chronic pain syndrome. The las was inserted, and the delivery device was advanced into the efferent loop by electrocautery fig. The other type of loop syndrome is afferent loop syndrome. Despite a difficult initial treatment phase, the patient is disease free and doing well after two and half years of completing treatment for the. Treatment by means of the placement of dual stents article pdf available in american journal of roentgenology 1996. In efferent loop syndrome, a portion or limb of the small intestine becomes blocked. The loop going to the upper stomach is the afferent loop. Afferent loop syndrome has been defined as an acute or chronic mechanical obstruction of the afferent limb following subtotal gastrectomy with billroth ii anastomosis or duodenojejunostomy following a pyloricpreserving whipple procedure.
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