Post-gastrojejunostomy afferent loop dilatation and content retention lead to a series of symptoms, often associated with afferent loop hypotonia, excessive length with kinking, or efferent loop obstruction, resulting in impaired duodenal emptying.

bubble_chart Diagnosis

Medical history inquiry:

① Acute afferent loop obstruction: Sudden severe upper abdominal pain, frequent vomiting without bile in the vomitus, no relief of symptoms after vomiting. In severe cases, extreme duodenal dilation, intestinal wall necrosis, and perforation may occur, leading to acute peritonitis.

② Chronic afferent loop syndrome: Right upper abdominal discomfort and distending pain occur 15–30 minutes after meals, followed by sudden vomiting of a large amount of bile, which promptly relieves the symptoms.

Physical examination findings:

Acute afferent loop obstruction: Upper abdominal tenderness, palpable suspicious mass or dilated intestinal loop, followed by increased pulse rate, decreased blood pressure, and other signs of shock. Chronic afferent loop syndrome: In long-term cases, the duodenum and afferent jejunal loop may be significantly dilated, and a mass may be palpable in the abdomen.

Auxiliary examinations:

Abdominal plain film may reveal dilated intestinal loops in the right upper abdomen with giant fluid levels. Barium meal examination can confirm marked dilation of the duodenum and afferent jejunal loop.

bubble_chart Treatment Measures

Acute afferent loop obstruction:

Prompt surgical intervention is required to relieve the obstruction, and a side-to-side anastomosis between the afferent and efferent loops of the jejunum should be performed.

Chronic afferent loop syndrome:

If the obstruction is not severe, symptoms can be alleviated by adjusting body position (adopting a right-sided prone position) and using anti-inflammatory and anti-edema medications. Definitive treatment still requires elective surgery.