[Reconstructive surgery for the afferent loop syndrome complicating indurative pancreatitis and mechanical jaundice].
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The author observed 27 patients with the adducent loop mechanic syndrome (ALMS), which was caused by scarring deformations, ulcerous and cancer process in the region of anastomosis, constructed after one of Billroth-2 technics, impairing evacuation of the adducent loop content. The diagnosis was established on the basis of clinical findings and pinpointed further by roentgenoscopy and fibrogastroscopy. The presence of helminthic invasion of the liver--opisthordiasis resulted in hepatitis, pancreatitis that would not respond to therapy in patients with ALMS. Conservative measures in this syndrome yield but only a provisional effect. Eighteen patients were operated upon.
A patient who had a 50% gastrectomy with a Billroth II gastrojejunostomy one and a half years previously, complained of recent severe weakness as the only symptom was found to have an iron deficiency anemia with a periumbilical mass. A gastrointestinal series showed a soft tissue density in the epigastric area which, by ultrasonography, was found to be fluid-containing. Laparotomy revealed obstruction of the afferent loop caused by a marginal ulcer.
It is the author's opinion that diagnosis of the "adducent loop syndrome" is unlikely to be correct in patients subjected to Billroth-II gastrectomy. As evidence by the author's observations pains in the right subcostal space, bile vomiting following the gastric resection are mostly due to diseases of the pancreas, bile outflow passages and liver.
ALS, a rare condition, is often difficult to diagnose clinically but has a characteristic CT appearance as a U-shaped, fluid-filled tubular structure crossing the midline between the abdominal aorta and the superior mesenteric artery. Radiologists should be familiar with this rare entity, as awareness of its pathognomonic CT features will aid in establishing the correct diagnosis as well as in offering a tentative etiology as a guide for treatment.
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