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Afferent Loop Syndrome
Discussion in 'All Categories' started by Dr Shilpi Sethi - Feb 15th, 2017 5:14 pm.
Dr Shilpi Sethi
Dr Shilpi Sethi
The patient is a diabetic since over last 20 years and is on insulin. On July 2014, his disease started with vomiting and food particles eaten 2 days back were noticed while brushing. Endoscopy was conducted at AMRI Hospital, Bhubaneswar and other hospitals. However, the endoscopy tube could not be inserted to the desired depth as it was obstructed midway. CT Scan was done at KIMS, Bhubaneswar and on 04.08.2014, Surgery was conducted by Dr. Md. Ibrahulla at Apollo Hospitals, Bhubaneswar. It was followed by Chemotherapy by Dr. Anupama Sasmal at Apollo Hospitals, Bhubaneswar in the last week of August 2014. The patient underwent 6 cycles of chemotherapy till 08-12-2014. He was asked to report after 2 months for follow-up check with upper G.I. Endoscopy, Sigmoidoscopy and CECT scan of whole Abdomen.

On 26//02/2015, all the above reports were shown to Dr. Anupama Sasmal who advised follow-up check-up after 3 months with upper G.I. Endoscopy and CECT scan of whole abdomen. On 30-05-2015, Ultrasound of whole abdomen was done which showed the impression of "Hypoechoic area of size 15mm in Pancreatic head".

On 13/10/2015, CECT Scan of whole abdomenn was done which showed disease recurrance. Dr. Anupama Sasmal advised for next chemotherapy which the patient underwent from 14-10-2015 to 07-12-2015. On 26-12-2015, CECT Scan of whole abdomen was done again and the chemotherapy continued from 28-12-2015 to 10-02-2016, after which the reports showed no presence of cancer in the stomach.

On 13-07-2016, following stomach pain and vomiting, another CECT Scan of the whole abdomen was done which showed Midline Supraumbilical Hernia with herniation of distal ileal loop with obstruction. It was operated on in July 2016 wherein the obstruction was released and mesh repair under GA was done. Post operative period was uneventful.

On 02-01-2017, following vomiting and stomach pain, he was advised X-ray abdomen erect by Dr. Md. Ibrahulla. The X-ray showed mildly distended small bowel loops, following which he was given medicines for 3 days. However, the patient's condition did not improve even after 3 days and he was admitted in the Apollo Hospitals. A CECT scan of the whole abdomen showed partial gastrectomy with gastro-jejunostomy. Dr. Ibrahulla reported recurrence of Carcinoma Stomach and he was operated (Ileo-Transverse Colostomy & Exploratory Laparotomy) on 06/01/2017. However, the patient's condition did not improve. So, he was again operated (Intestinal Obstruction Operation) on 14/01/2017. However, the patient's symptoms persisted and an UGI Endoscopy was done on 17/01/2017, following which the patient's condition improved drastically and he was discharged on 20-01-2017.

However, after the vomiting resumed, we were advised to do a scan again which diagnosed Afferent loop syndrome. I am forwarding all reports as attachments. Please understand that we are contacting you primarily for non surgical treatment of afferent loop syndrome and not for cancer treatment.
re: Afferent Loop Syndrome by Dr Rahul - Feb 15th, 2017 5:34 pm
Dr Rahul
Dr Rahul
Dr Shilpi Sethi

The afferent loop syndromes result from obstruction to the afferent jejunal loop after gastrojejunostomy. Acute afferent loop syndrome results from complete obstruction, usually occurs early after surgery and runs a devastatingly lethal course unless promptly treated by reoperation.

In chronic afferent loop syndrome the obstruction is intermittent and produces a clinical syndrome. Weinberg pyloroplasty is the treatment of choice of afferent loop syndrome. No effective conservative management. No effective medical treatment is available and patients with no other contraindication should have revisional surgery if symptoms are clinically significant.

Unfortunately frequently most of the cancer patient cannot be confirmed as surgical candidates due to poor medical condition. In those patient endoscopic stent insertion can be an effective treatment. Endoscopic enteral metal stent placement appears to be a promising technique with effective palliation in these patients.

You can bring the patient for this procedure to our hospital.

With regard

Dr Rahul
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