title: Total Reconstruction of the Afferent Loop for Treatment of Radiation-Induced Afferent Loop Obstruction with Segmental Involvement after Pancreaticoduodenectomy with Roux-en-Y Reconstruction.
abstract: As the literature on afferent loop obstruction (ALO) after pancreaticoduodenectomy (PD) is very limited, standardized rules for its management do not exist. Herein, we report the case of a 65-year-old male patient with chronic ALO who had undergone PD with single Roux-en-Y limb reconstruction and adjuvant chemoradiation therapy for pancreatic head adenocarcinoma 2 years earlier. The patient was brought to the operating room with the diagnosis of radiation enteritis of the afferent loop with segmental involvement and concurrent hepaticojejunostomy (HJ) and pancreaticojejunostomy (PJ) stricture. Complete mobilization of the afferent loop, removal of the affected segment and reconstruction were performed. Reconstruction of the afferent loop was a one-way option for the surgeons because the Roux-en-Y reconstruction limited endoscopic access to the afferent loop, and the segmental radiation injury of the afferent loop ruled out bypass surgery. However, mobilization of the affected segment through a field of dense adhesions and revision of the HJ and PJ were technically demanding.
authors.affiliation: Department of General Surgery, General Hospital of Drama, Drama, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Blouhos
authors.forename: Konstantinos A
authors.initials: KA
authors.lastname: Boulas
authors.forename: Ilias I
authors.initials: II
authors.lastname: Salpigktidis
authors.forename: Anna
authors.initials: A
authors.lastname: Konstantinidou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Ioannidis
authors.forename: Anestis
authors.initials: A
authors.lastname: Hatzigeorgiadis
keywords: Afferent loop obstruction; Pancreaticoduodenectomy; Radiation enteritis; Roux-en-Y reconstruction; Surgery
references.citation: Gastrointest Endosc. 2011 Aug;74(2):295-302
references.pmid: 21689816
references.citation: Clin Imaging. 2006 Jul-Aug;30(4):283-6
references.pmid: 16814147
references.citation: HPB (Oxford). 2010 Sep;12(7):482-7
references.pmid: 20815857
references.citation: Int J Surg Oncol. 2012;2012:218248
references.pmid: 23008765
references.citation: World J Surg. 1992 May-Jun;16(3):521-4
references.pmid: 1350387
references.citation: AJR Am J Roentgenol. 2001 May;176(5):1105-16
references.pmid: 11312162
references.citation: Ann Ital Chir. 2012 Nov-Dec;83(6):555-8
references.pmid: 23110908
references.citation: HPB (Oxford). 2010 Apr;12(3):211-6
references.pmid: 20590889
references.citation: Hepatogastroenterology. 2008 May-Jun;55(84):1093-8
references.pmid: 18705336