Adjacent loop syndrome is a pathological condition that develops after Billroth- II stomach resection , manifested by a feeling of heaviness in the right hypochondrium and vomiting of bile after eating. The frequency of this syndrome, according to various authors, ranges from 0.8 to 51.9%.
Etiology, pathogenesis of afferent loop syndrome
Acute syndrome of the leading loop develops with complete obstruction and, as a rule, in the early postoperative period. The reasons are most often various mechanical factors and only sometimes the atony of the afferent loop. Chronic afferent loop syndrome is most often the result of functional disorders – duodenal hypotension, its dyskinesia, anastomosis spasm and abduction loop. With peptic ulcer of gastro – enteroanastomosis , when the ulcerative infiltrate compresses the outlet loop, a secondary chronic syndrome of the leading loop of a mechanical nature may develop. Kinks and adhesions in the area of the anastomosis can lead to it.
Clinical Loop Syndrome Clinic
With a mild severity of the syndrome, rare spitting up or mild vomiting of bile is observed 15 minutes to 2.5 hours after eating. Patients often do not attach any importance to these phenomena, the ability to work is preserved. The syndrome of moderate severity is manifested by bursting, quite intense pain in the right hypochondrium after eating and vomiting of bile, which occurs quite often, as well as a decrease in body weight and a significant decrease in working capacity. The severe severity of the afferent loop syndrome is characterized by profuse vomiting of bile after each meal. Vomiting is usually preceded by excruciating pain in the right hypochondrium and epigastric region. Patients are exhausted, their ability to work is reduced. In most patients , the afferent loop syndrome develops in the 1st year after surgery, and in some, even within the 1st month.
Diagnosis of the afferent loop syndrome
Diagnosis of the afferent loop syndrome should be based primarily on the clinical picture. The X-ray method of research, which primarily reveals organic pathology and some functional changes in the stomach stump, leading and removing loops, the anastomotic region, has a certain significance in recognizing the syndrome. Refluxing the contrast medium into the lead loop (reflux) cannot be a reliable sign of the lead loop syndrome, since it occurs only in 20-30% of patients with clear clinical signs of this syndrome.