A case of afferent loop syndrome

Afferent loop syndrome (ALS) is an uncommon complication that can occur after gastric surgery. Symptoms are non-specific and a high suspicion index is needed. Abdominal computed tomography (CT) scan is the gold-standard in diagnosis and acutely ALS represents a true surgical emergency. We present a case of acute ALS due to afferent loop internal hernia, years after gastric surgery. A 45-year-old Caucasian male submitted to an open distal subtotal gastrectomy with Roux-en-Y reconstruction for a perforated peptic ulcer performed 13 years previously, presented with persistent epigastric pain, with nausea and vomiting, and a distended abdomen with guarding in the upper quadrants. Abdominal CT-scan images showed duodenum and proximal jejunum dilation. Acute complicated ALS due to an internal hernia was diagnosed, and patient was submitted to emergent surgery. ALS is a rare but serious complication that can happen after a gastrectomy with Roux-en-Y reconstruction. An internal hernia is an uncommon mechanical cause of acute obstructive ALS. Some patients may present several years after surgery. Many conditions can mimic ALS. Correct diagnosis and intervention are essential to reduce morbidity and mortality. Treatment strategy should be defined case-by-case, and surgery must not be delayed if complete obstruction develops. ALS should be considered in patients who had gastric surgery and present with acute and/or recurrent abdominal pain, irrespective of time from surgery. Acute form is a true surgical emergency. Favorable outcomes depend on early diagnosis and prompt management. Surgery provides definitive treatment when ALS is due to an internal hernia.