Acute pancreatitis and afferent loop syndrome. Case report

Background: The afferent syndrome loop, it's a mechanic obstruction of the afferent limb before a Billroth II or Roux-Y reconstruction, secondary in most of case at distal or subtotal gastrectomy. Clinic case: Male 76 years old, with antecedent of cholecystectomy, gastric adenocarcinoma six years ago, with subtotal gastrectomy and Roux-Y reconstruction. Beginning a several abdominal pain, nausea and vomiting, abdominal distension, without peritoneal irritation sings. Amylase 1246 U/L, lipase 3381 U/L. Computed Tomography whit thickness wall and dilatation of afferent loop, pancreas whit diffuse enlargement, makes diagnostic of acute pancreatitis secondary an afferent loop syndrome. Conclusion: The afferent loop syndrome is presented in 0.3%-1% in all cases with Billroth II reconstruction, with a mortality of up to 57%, the obstruction lead accumulation of bile, pancreatic and intestinal secretions, increasing the pressure and resulting in afferent limb, bile conduct and Wirsung conduct dilatation, triggering an inflammatory response that culminates in pancreatic inflammation. The severity of the presentation is related to the degree and duration of the blockage.