title: Using multidetector-row CT for the diagnosis of afferent loop syndrome following gastroenterostomy reconstruction.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.
authors.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.
authors.forename: Yu-Hsiu
authors.initials: YH
authors.lastname: Juan
authors.forename: Chih-Yung
authors.initials: CY
authors.lastname: Yu
authors.forename: Hsian-He
authors.initials: HH
authors.lastname: Hsu
authors.forename: Guo-Shu
authors.initials: GS
authors.lastname: Huang
authors.forename: De-Chuan
authors.initials: DC
authors.lastname: Chan
authors.forename: Chang-Hsien
authors.initials: CH
authors.lastname: Liu
authors.forename: Ho-Jui
authors.initials: HJ
authors.lastname: Tung
authors.forename: Wei-Chou
authors.initials: WC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000343:Afferent Loop Syndrome / Q000000981:diagnostic imaging*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005763:Gastroenterostomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*