Korean J Gastroenterol.  2011 Mar;57(3):194-197. 10.4166/kjg.2011.57.3.194.

A Case of Acute Pancreatitis due to Afferent Loop Syndrome with Internal Hernia

• Park JW
• Lee JH
• Kim SJ
• Park HW
• Kim HS
• Shin WG
• Kim KH
• Kim HY

• KMID: 1128360
• DOI: http://doi.org/10.4166/kjg.2011.57.3.194

Abstract

Acute pancreatitis and afferent loop syndrome (ALS) have similar symptoms and physical findings. Accurate early diagnosis is essential, as the management of acute pancreatitis is predominantly conservative whereas ALS usually requires surgery. We experienced one case of pancreatitis due to ALS with internal hernia. Laboratory findings of patient showed elevated serum amylase, lipase and WBC count. One day after admission, diagnosis was modified as acute pancreatitis caused by ALS on computed tomography. Patient was managed with surgical treatment and operation finding revealed ALS due to internal hernia. He was recovered well after surgical treatment and discharged without significant sequelae.

Keyword

Pancreatitis; Afferent loop syndrome; Gastrectomy; Hernia

MeSH Terms

Acute Disease
Afferent Loop Syndrome/complications/*diagnosis/surgery
Endoscopy, Gastrointestinal
Gallstones
Hernia, Abdominal/*complications
Humans
Male
Middle Aged
Pancreatitis/*diagnosis/etiology
Radiography, Abdominal
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. The erect plain abdominal film on admission. No abnormal bowel gas or calcified lesions were noted.

• 

  Fig. 2. Abdominal CT scan on the second hospital day. It showed marked dilatation of the afferent loop, filled with fluid.

• 

  Fig. 3. Endoscopic findings on the second hospital day. (A) Narrowing of bowel lumen was noted, just below the gastrojejunostomy site. (B) After removal of large amount of bile contained fluid, slight edematous afferent loop was noted. (C) Endoscopic nasobiliary drainage (ENBD) tube was inserted after suction of fluid. (D) The ENBD tube, was located through the strangulated site.

• 

  Fig. 4. Intraoperative findings on the third hospital day. (A) Efferent loop ‘E’ seemed normal, but the strangulation and dilation of afferent loop A was observed. Perforation ‘P’ of strangulated bowel is also noted. (B) After the deflection of efferent loop ‘E’, reducted afferent loop ‘A’ with perforation ‘P’ from herniated site ‘H’ was well visualized.

Reference

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