Editing Gastrectomy (section)

=== '''Afferent     loop syndrome''' ===

** This is the duodenojejunal      loop proximal to the gastrojejunal anastomosis after either a Billroth II      or gastrojejunostomy. Occurs as a result of partial obstruction of the      afferent limb, which is then unable to empty its contents.
** A long afferent limb is      usually the underlying problem
** Pancreatic and hepatobiliary      secretions accumulate, resulting in distension and cramping
** The intraluminal pressure      eventually increases enough to empty the contents of the afferent loop      forcefully into the stomach, resulting in projectile bilious vomiting      that immediately relieves symptoms.
** Can be aggravated by blind      loop syndrome - bacterial overgrowth occurs in the static loop, and the      bacteria bind with vitamin B12 - leading to megaloblastic anaemia, fat      malabsorption and deficiency in fat-soluble vitamins.
** Investigation
*** Failure to visualise the       afferent limb on upper endoscopy is suggestive
*** Radionuclide studies       imaging the hepatobiliary tree have also been used with some success -       normally should pass into the stomach/distal small bowel after being       excreted; if this does not happen, consider afferent loop obstruction.
** Management
*** Surgical correction
**** Convert the Billroth II        into a Billroth I
**** Enteroenterostomy below        the afferent and efferent loops
**** Conversion to a Roux-en-Y        reconstruction