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Using multidetector-row CT for the diagnosis of afferent loop syndrome following gastroenterostomy reconstruction.

Juan YH, Yu CY, Hsu HH, Huang GS, Chan DC, Liu CH, Tung HJ, Chang WC - Yonsei Med. J. (2011)

Bottom Line: We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS.These etiologies and associated complications can be predicted 100% by MDCT.Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gong Road, Nei-Hu, Taipei 114, Taiwan, Republic of China.

ABSTRACT

Purpose: To assess the clinical manifestations and multidetector-row computed tomography (MDCT) findings of afferent loop syndrome (ALS) and to determine the role of MDCT on treatment decisions.

Materials and methods: From January 2004 to December 2008, 1,100 patients had undergone gastroenterostomy reconstruction in our institution. Of these, 22 (2%) patients were diagnosed as ALS after surgery that included Roux-en-Y gastroenterotomy (n=9), Billroth-II gastrojejunostomy (n=7), and Whipple's operation (n=6). Clinical manifestations and MDCT features of these patients were recorded and statistically analyzed. The presumed etiologies of obstruction shown on the MDCT were correlated with clinical information and confirmed by surgery or endoscopic biopsy.

Results: The most common clinical symptom was acute abdominal pain, presenting in 18 patients (82%). We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS. Malignant causes of ALS, such as local recurrence and carcinomatosis, are the most common etiologies of obstruction. These etiologies and associated complications can be predicted 100% by MDCT.

Conclusion: Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.

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Related in: MedlinePlus

Afferent loop obstruction in a 58-year-old man after Roux-en-Y gastroenterotomy. (A) Abdominal radiograph shows no remarkable findings. There is no evidence of intestinal obstruction or abnormal free extraluminal air accumulation. (B) Coronal plane of MDCT reveals perforation (arrow) of the dilated fluid-filled afferent loop. The C-loop appearance is well demonstrated, but the keyboard sign is not visualized. There is no focal bowel wall thickening or mass lesion at the anastomosis. Massive ascites and peritoneal enhancement are present, suggesting carcinomatosis. The second operation confirmed the MDCT diagnosis of carcinomatosis.
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Figure 2: Afferent loop obstruction in a 58-year-old man after Roux-en-Y gastroenterotomy. (A) Abdominal radiograph shows no remarkable findings. There is no evidence of intestinal obstruction or abnormal free extraluminal air accumulation. (B) Coronal plane of MDCT reveals perforation (arrow) of the dilated fluid-filled afferent loop. The C-loop appearance is well demonstrated, but the keyboard sign is not visualized. There is no focal bowel wall thickening or mass lesion at the anastomosis. Massive ascites and peritoneal enhancement are present, suggesting carcinomatosis. The second operation confirmed the MDCT diagnosis of carcinomatosis.

Mentions: The MDCT image findings are summarized in Table 3. Bowel wall thickening was evident in 13 patients and localized to the anastomosis in eight, who were confirmed to have local recurrence. The maximal diameter of the afferent loop ranged from 3.3 to 5.8 cm. We found that the keyboard sign and C-loop appearance was present in 21 (95%) and 22 patients (100%), respectively. The figure is an example of typical MDCT findings for ALS (Fig. 1). There was only one patient without presence of the keyboard sign (Fig. 2), due to bowel perforation. There was no statistical significance for other associated imaging findings, including the presence of common bile duct dilatation, pancreatic duct dilatation, and ascites.


Using multidetector-row CT for the diagnosis of afferent loop syndrome following gastroenterostomy reconstruction.

Juan YH, Yu CY, Hsu HH, Huang GS, Chan DC, Liu CH, Tung HJ, Chang WC - Yonsei Med. J. (2011)

Afferent loop obstruction in a 58-year-old man after Roux-en-Y gastroenterotomy. (A) Abdominal radiograph shows no remarkable findings. There is no evidence of intestinal obstruction or abnormal free extraluminal air accumulation. (B) Coronal plane of MDCT reveals perforation (arrow) of the dilated fluid-filled afferent loop. The C-loop appearance is well demonstrated, but the keyboard sign is not visualized. There is no focal bowel wall thickening or mass lesion at the anastomosis. Massive ascites and peritoneal enhancement are present, suggesting carcinomatosis. The second operation confirmed the MDCT diagnosis of carcinomatosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104453&req=5

Figure 2: Afferent loop obstruction in a 58-year-old man after Roux-en-Y gastroenterotomy. (A) Abdominal radiograph shows no remarkable findings. There is no evidence of intestinal obstruction or abnormal free extraluminal air accumulation. (B) Coronal plane of MDCT reveals perforation (arrow) of the dilated fluid-filled afferent loop. The C-loop appearance is well demonstrated, but the keyboard sign is not visualized. There is no focal bowel wall thickening or mass lesion at the anastomosis. Massive ascites and peritoneal enhancement are present, suggesting carcinomatosis. The second operation confirmed the MDCT diagnosis of carcinomatosis.
Mentions: The MDCT image findings are summarized in Table 3. Bowel wall thickening was evident in 13 patients and localized to the anastomosis in eight, who were confirmed to have local recurrence. The maximal diameter of the afferent loop ranged from 3.3 to 5.8 cm. We found that the keyboard sign and C-loop appearance was present in 21 (95%) and 22 patients (100%), respectively. The figure is an example of typical MDCT findings for ALS (Fig. 1). There was only one patient without presence of the keyboard sign (Fig. 2), due to bowel perforation. There was no statistical significance for other associated imaging findings, including the presence of common bile duct dilatation, pancreatic duct dilatation, and ascites.

Bottom Line: We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS.These etiologies and associated complications can be predicted 100% by MDCT.Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gong Road, Nei-Hu, Taipei 114, Taiwan, Republic of China.

ABSTRACT

Purpose: To assess the clinical manifestations and multidetector-row computed tomography (MDCT) findings of afferent loop syndrome (ALS) and to determine the role of MDCT on treatment decisions.

Materials and methods: From January 2004 to December 2008, 1,100 patients had undergone gastroenterostomy reconstruction in our institution. Of these, 22 (2%) patients were diagnosed as ALS after surgery that included Roux-en-Y gastroenterotomy (n=9), Billroth-II gastrojejunostomy (n=7), and Whipple's operation (n=6). Clinical manifestations and MDCT features of these patients were recorded and statistically analyzed. The presumed etiologies of obstruction shown on the MDCT were correlated with clinical information and confirmed by surgery or endoscopic biopsy.

Results: The most common clinical symptom was acute abdominal pain, presenting in 18 patients (82%). We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS. Malignant causes of ALS, such as local recurrence and carcinomatosis, are the most common etiologies of obstruction. These etiologies and associated complications can be predicted 100% by MDCT.

Conclusion: Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.

Show MeSH
Related in: MedlinePlus