The purpose of this article is to assess the technical feasibility, clinical effectiveness, and optimal route of dual stent placement for afferent loop syndrome. This revealed that an extensive resection of the stomach had been performed previously, and only a. Endoscopic treatment of efferent loop syndrome with insertion. Afferent loop syndrome treated by eusguided gastrojejunostomy endoscopy 2017. Afferent loop syndrome definition of afferent loop. The efferent loop syndrome in a narrow sense refers only to obstruction of the efferent jejunal loop after gastric resection or simple gastroenterostomy. The other type of loop syndrome is afferent loop syndrome. Stay up to date with the latest health news and useful resources. Efferent loop syndrome health encyclopedia university of.
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. 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. 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. Rouxeny gastric bypass biliopancreatic diversion partial gastrectomy total gastrectomy partial pancreaticoduodenectomy whipple. We present a patient who had early efferent loop obstruction after gastrectomy due to a retained drain. Endoscopic jejunojejunostomy by use of a lumenapposing. Hyperperistalsis in the afferent loop may spread to the efferent loop and cause intestinal hurry. An obstruction of the afferent limb can present in various ways. Afferent loop syndrome can occur after some types of gastrojejunostomy. Endoscopic treatment of efferent loop syndrome with insertion of double pigtail stent. 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. A roux limb may be formed in multiple different gastrointestinal surgeries, including bariatric surgery, e. These terms have a slightly different meaning in the context of the peripheral nervous system pns and central nervous system cns.
Afferent loop syndrome als is caused by mechanical obstruction of the afferent loop of a doublebarrel gastrojejunostomy a. Afferent loop syndrome treated by endoscopic ultrasound. All aimed at helping you enjoy life by being aware of how to care for your health. Endoscopic treatment of efferent loop syndrome with.
Difference between afferent and efferent arterioles compare. Get a printable copy pdf file of the complete article 541k, or click on a page image below to browse page by page. Sensory neurones receive an impulse that is generat. 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. Afferent loop sydrome common after bilroth ii is characterized by post prandial ruq pain, bilious vomiting, anemia, steatorrhea, and pain which resolve. Endoscopic treatment of efferent loop syndrome with insertion of.
Afferent loop syndrome health encyclopedia university. Els can occur with reconstruction of the alimentary tract after a whipple procedure, billroth ii gastrectomy or rouxeny gastric bypass. Afferent loop syndrome after whipple procedure sages. Signs and symptoms of these two complications may be similar and difficult to distinguish. Afferent loop syndrome after rouxeny total gastrectomy. Its major functions include communication among the body parts and controlling. Key difference afferent vs efferent arterioles blood is supplied to the kidney via renal arteries. Afferent nerve fibers refer to axonal projections that arrive at a particular brain region, as opposed to efferent projections that exit the region. Efferent loop obstruction is a rare complication after gastrectomy and most literatures discuss on the commoner complication of afferent loop syndrome.
Nov 07, 20 afferent loop syndrome is commonly reported, while efferent loop syndrome is very rarely reported. 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. Afferent loop syndrome als is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. Pdf afferent loop syndrome als is a rare complication of billrothii gastrojejunostomy.
The major cause of syndrome is an intestinal hernia. Full text is available as a scanned copy of the original print version. Pdf the purpose of this article is to assess the technical feasibility and clinical effectiveness of the placement of partially covered. Afferent loop syndrome radiology reference article. Difference between afferent and efferent compare the. Afferent loop syndrome is a problem that can occur after some kinds of stomach surgery. 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. Finally, the las 15 mm 10 mm was deployed, and balloon dilation of the stent figure 1. Abdominal computed tomography scan revealed dilation of the duodenum and small intestine. Efferent loop syndrome in a postpancreatoduodenectomy. Afferent loop syndrome is a rare complication 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. Afferent loop syndrome definition of afferent loop syndrome. In a loop syndrome, part of the small intestine becomes blocked. 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. He had a history of total gastrectomy with a rouxeny reconstruction. Complications such as obstruction or dysfunction of the efferent jejunal loop, dumping syndrome. Division of afferent and efferent loops of jejunum. 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. Request pdf ct diagnosis of afferent loop syndrome to report the computed tomography ct features of afferent loop syndrome which is often clinically.
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. 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. Although balloon dilation andor stenting may be useful in special cases, the cornerstone of treatment for afferent loop obstruction in patients with curable cancer. The loop going to the upper stomach is the afferent loop. The las was inserted, and the delivery device was advanced into the efferent loop by electrocautery fig. 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. Treatment by means of the placement of dual stents.
Dec 07, 2017 an efferent arteriole is a part of the renal artery that carries filtered pure blood back to the circulatory system. When efferent loop syndrome happens, it is usually within the first few weeks after gastric bypass surgery. 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. 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. Afferent limb syndromes have decreased in incidence with newer surgical techniques to decrease the size of the limb. Jan 17, 2016 what does afferent loop syndrome mean in english. 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. The efferent fiber is a long process projecting far from the neurons body that carries nerve impulses away from the. 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.
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. Pdf efferent limb of gastrojejunostomy obstruction by a. Pdf acute afferent loop obstruction treated by endoscopic. Ct diagnosis of afferent loop syndrome request pdf. Etiologi entrapment or compression of the afferent loop. Despite a difficult initial treatment phase, the patient is disease free and doing well after two and half years of completing treatment for the. Acute als represents complete obstruction of the afferent loop and is a. Acute obstruction of afferent or efferent loop, following. Efferent loop syndrome is one of two loop syndromes that can happen after some types of gastric surgery. Causes include jejunal herniation, intussusception, kinking, volvulus, marginal ulceration, paraanastomotic stenosis, and adhesion. Efferent nerve fibers refer to axonal projections that exit a particular region.
The loop carrying food away from the stomach is called the efferent loop. 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. Difference between afferent and efferent arterioles key. Most cases of als are caused by obstruction from adhesions.
Slow transit gastric stasis alkaline gastritis roux stasis syndrome. Afferent loop syndrome health encyclopedia university of. Treatment by means of the placement of dual stents article pdf available in american journal of roentgenology 1996. Without pain, and usually in the morning after getting up or some time after. 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. In a postop whipple patient, an acute afferent limb obstruction is especially concerning because theres a fresh bilary anastomosis potentially at risk. The interlobular artery is the first branch of the renal artery. Afferent loop syndrome is a mechanical bowel obstruction internal hernia, volvulus, stricturing, etc that results in an effective biliary outlet obstruction. 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. The various methods used to reestablish gastroenteric continuity after subtotal gastrectomy still do not totally obviate unpleasant complications and sequelae. Without pain, and usually in the morning after getting up or some time after meals bilestained vomiting occurs without any food contents. 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. Delay in emptying the afferent loop causes inadequate mixing of the duo denal contents and food.
Links to pubmed are also available for selected references. 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. Afferent loop syndrome definition, symptoms, causes. A 73yearold man presented with one day of persistent abdominal pain, gradually radiating to the back. 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. Causes include jejunal herniation, intussusception, kinking, volvulus, marginal ulceration, paraanastomotic stenosis, and adhesion formation. Nonsurgical treatment for afferent loop syndrome in. 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.
Kinked efferent loop guidewire inserted and blind loop at site of. Efferent loop syndrome is a rare post gastectomy syndrome, while afferent loop syndrome is more common. Afferent and efferent loop syndrome jejunal intussusception internal hernia. Efferent loop syndrome is one of two loop syndromes that can happen after some types of gastric. The treatment may involve medical therapy or surgery. The distal end of this loop was anastomosed to the end of the. Afferent loop syndrome an overview sciencedirect topics. These arteries are branching directly from the aorta. Know why a new medicine or treatment is prescribed, and how it will help you. Als may be surgically corrected by deconstructing the billroth ii gastrojejunostomy and restoring gastrointestinal continuity with a rouxeny gastrojejunostomy b.
The proximal jejunal loop was transected near the point of attachment on the lesser curvature of the stomach. Afferent loop syndrome is a rare complication that occurs in 0. 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. 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. Difference between afferent and efferent arterioles. Whipple procedures are mainly used to treat patients with pancreatic head and periampullary tumors as well as for those with chronic pain syndrome. Efferent loop syndrome is one of two loop syndromes that can happen after. The efferentloop syndrome in a narrow sense refers only to obstruction of the efferent jejunal loop after gastric resection or simple gastroenterostomy. In some cases of blind loop syndrome, overgrowth of pathogenic non commensal bacteria has also been noted. Afferent loop syndrome is not an uncommon postoperative complication, and one study has estimated that it occurs in % of postpancreaticoduodenectomy patients 2. Anastomotic stricture and ulcers, bowel adhesions, jejenogastric intussusception and anastomotic cancer may be a cause much later.
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