title: Afferent loop syndrome complicated by a duodenal phytobezoar after Billroth-II subtotal gastrectomy.
abstract: We illustrate a rare late onset (10 yr) complication of gastric surgery with a combination of afferent loop syndrome and a large duodenal bezoar. The patient underwent a subtotal gastrectomy with Billroth II gastrojejunal anastomosis for benign peptic ulcer 10 yr ago. It was not until several days before this presentation that he suffered from epigastralgia and abdominal distension. Leukocytosis and abnormal blood biochemistry were found including amylase, lipase, alkaline phosphatase, total bilirubin, GOT, and GPT in which amylase was markedly elevated to 1188 U/L. Abdominal ultrasound scan and especially CT scan confirmed the diagnosis of a large bezoar in the dilated duodenal afferent loop. To our knowledge, the rare entity in our case is the first reported in the literature.
authors.affiliation: Department of Diagnostic Radiology, Internal Medicine, Pathology and Laboratory Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: M S
authors.initials: MS
authors.lastname: Hui
authors.forename: H L
authors.initials: HL
authors.lastname: Perng
authors.forename: W M
authors.initials: WM
authors.lastname: Choi
authors.forename: L K
authors.initials: LK
authors.lastname: Chem
authors.forename: K C
authors.initials: KC
authors.lastname: Yang
authors.forename: T J
authors.initials: TJ
authors.lastname: Chen
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000343:Afferent Loop Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D000681:Amylases / Q000097:blood; D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001219:Aspartate Aminotransferases / Q000097:blood; D001630:Bezoars / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001663:Bilirubin / Q000097:blood; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007583:Jejunum / Q000601:surgery; D007964:Leukocytosis / Q000209:etiology; D008049:Lipase / Q000097:blood; D008297:Male; D010437:Peptic Ulcer / Q000601:surgery; D011183:Postoperative Complications; D013270:Stomach / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D008049:Lipase; D000469:Alkaline Phosphatase; D000681:Amylases; D001663:Bilirubin