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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 35-year-old woman after Billroth-II gastrojejunostomy. (A) Axial plane of MDCT shows bowel wall thickening (arrow) instead of appreciable lobulated mass-like lesion at the anastomosis area. (M: liver metastasis) (B) Coronal plane of MDCT clearly demonstrates the lobulated contour of soft-tissue mass (arrows) at the anastomosis, suggesting local recurrence. (C) Another coronal plane of MDCT demonstrates the fluid-filled C-shaped afferent loop (C), in combination with valvulae conniventes projecting into the lumen (arrowheads). This MDCT finding is highly suggestive of bowel obstruction. The endoscopic biopsy confirmed the MDCT diagnosis of local recurrence inducing afferent loop syndrome. MDCT, multidetector-row computed tomography.
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Figure 3: Afferent loop obstruction in a 35-year-old woman after Billroth-II gastrojejunostomy. (A) Axial plane of MDCT shows bowel wall thickening (arrow) instead of appreciable lobulated mass-like lesion at the anastomosis area. (M: liver metastasis) (B) Coronal plane of MDCT clearly demonstrates the lobulated contour of soft-tissue mass (arrows) at the anastomosis, suggesting local recurrence. (C) Another coronal plane of MDCT demonstrates the fluid-filled C-shaped afferent loop (C), in combination with valvulae conniventes projecting into the lumen (arrowheads). This MDCT finding is highly suggestive of bowel obstruction. The endoscopic biopsy confirmed the MDCT diagnosis of local recurrence inducing afferent loop syndrome. MDCT, multidetector-row computed tomography.

Mentions: The curable causes of ALS such as adhesions or internal hernia or local recurrence should be identified by the radiologists. These causes might be properly managed by surgery. Conservative therapy has often been chosen for patients with ALS resulting from carcinomatosis because of their debilitated state or disseminated tumor. Kim, et al.2 demonstrated that the causes of afferent loop obstruction can be correctly predicted with axial plane CT in most cases. In our study, we believed that MDCT with coronal reformation is superior to axial plane CT in some situations, because problems related to partial volume effect on the axial plane are eliminated and the anatomical relationship of the organs is defined with easy compartmentalization of associated pathology (Fig. 3). Spatial resolution is better than with multiplanar reformatted images. With axial plane and coronal reformation images, we can predict curable or non-curable causes of ALS precisely and properly treat these patients by means of surgery, chemotherapy, or conservative management. However, in patients without peritoneal enhancement and ascites (non-disseminated carcinomatosis), preoperative identification of the etiology of ALS by MDCT is difficult in clinical practice.18


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 35-year-old woman after Billroth-II gastrojejunostomy. (A) Axial plane of MDCT shows bowel wall thickening (arrow) instead of appreciable lobulated mass-like lesion at the anastomosis area. (M: liver metastasis) (B) Coronal plane of MDCT clearly demonstrates the lobulated contour of soft-tissue mass (arrows) at the anastomosis, suggesting local recurrence. (C) Another coronal plane of MDCT demonstrates the fluid-filled C-shaped afferent loop (C), in combination with valvulae conniventes projecting into the lumen (arrowheads). This MDCT finding is highly suggestive of bowel obstruction. The endoscopic biopsy confirmed the MDCT diagnosis of local recurrence inducing afferent loop syndrome. MDCT, multidetector-row computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Afferent loop obstruction in a 35-year-old woman after Billroth-II gastrojejunostomy. (A) Axial plane of MDCT shows bowel wall thickening (arrow) instead of appreciable lobulated mass-like lesion at the anastomosis area. (M: liver metastasis) (B) Coronal plane of MDCT clearly demonstrates the lobulated contour of soft-tissue mass (arrows) at the anastomosis, suggesting local recurrence. (C) Another coronal plane of MDCT demonstrates the fluid-filled C-shaped afferent loop (C), in combination with valvulae conniventes projecting into the lumen (arrowheads). This MDCT finding is highly suggestive of bowel obstruction. The endoscopic biopsy confirmed the MDCT diagnosis of local recurrence inducing afferent loop syndrome. MDCT, multidetector-row computed tomography.
Mentions: The curable causes of ALS such as adhesions or internal hernia or local recurrence should be identified by the radiologists. These causes might be properly managed by surgery. Conservative therapy has often been chosen for patients with ALS resulting from carcinomatosis because of their debilitated state or disseminated tumor. Kim, et al.2 demonstrated that the causes of afferent loop obstruction can be correctly predicted with axial plane CT in most cases. In our study, we believed that MDCT with coronal reformation is superior to axial plane CT in some situations, because problems related to partial volume effect on the axial plane are eliminated and the anatomical relationship of the organs is defined with easy compartmentalization of associated pathology (Fig. 3). Spatial resolution is better than with multiplanar reformatted images. With axial plane and coronal reformation images, we can predict curable or non-curable causes of ALS precisely and properly treat these patients by means of surgery, chemotherapy, or conservative management. However, in patients without peritoneal enhancement and ascites (non-disseminated carcinomatosis), preoperative identification of the etiology of ALS by MDCT is difficult in clinical practice.18

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