A Case of Acute Pancreatitis due to Afferent Loop Syndrome with Internal Hernia

Jong Won Park; Jin Heon Lee; Sung Jun Kim; Hye Won Park; Hyoung Su Kim; Woon Geon Shin; Kyung Ho Kim; Hak Yang Kim

doi:10.4166/kjg.2011.57.3.194

Journal List > Korean J Gastroenterol > v.57(3) > 1006787

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Park, Lee, Kim, Park, Kim, Shin, Kim, and Kim: A Case of Acute Pancreatitis due to Afferent Loop Syndrome with Internal Hernia

Case Report

Korean J Gastroenterol 2011;57(3):194-197.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.57.3.194

A Case of Acute Pancreatitis due to Afferent Loop Syndrome with Internal Hernia

Jong Won Park, Jin Heon Lee, Sung Jun Kim, Hye Won Park, Hyoung Su Kim, Woon Geon Shin, Kyung Ho Kim, Hak Yang Kim

Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

Correspondence to: Jin Heon Lee, Department of Internal Medicine, Gangdong Sacred Heart Hospital, Hallym University College of Medicine, 445, Gil 1-dong, Gangdong-gu, Seoul 134-701, Korea. Tel: +82-2-2224-2518, Fax: +82-2-478-6925, E-mail: seether@hallym.or.kr

Received 26 May 2010 Revised 15 August 2010 Accepted 26 August 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Acute pancreatitis and afferent loop syndrome (ALS) have similar symptoms and physical findings. Accurate early diagnosis is essential, as the management of acute pancreatitis is predominantly conservative whereas ALS usually requires surgery. We experienced one case of pancreatitis due to ALS with internal hernia. Laboratory findings of patient showed elevated serum amylase, lipase and WBC count. One day after admission, diagnosis was modified as acute pancreatitis caused by ALS on computed tomography. Patient was managed with surgical treatment and operation finding revealed ALS due to internal hernia. He was recovered well after surgical treatment and discharged without significant sequelae.

Keywords: Pancreatitis, Afferent loop syndrome, Gastrectomy, Hernia

References

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Fig. 1.

The erect plain abdominal film on admission. No abnormal bowel gas or calcified lesions were noted.

Fig. 2.

Abdominal CT scan on the second hospital day. It showed marked dilatation of the afferent loop, filled with fluid.

Fig. 3.

Endoscopic findings on the second hospital day. (A) Narrowing of bowel lumen was noted, just below the gastrojejunostomy site. (B) After removal of large amount of bile contained fluid, slight edematous afferent loop was noted. (C) Endoscopic nasobiliary drainage (ENBD) tube was inserted after suction of fluid. (D) The ENBD tube, was located through the strangulated site.

Fig. 4.

Intraoperative findings on the third hospital day. (A) Efferent loop ‘E’ seemed normal, but the strangulation and dilation of afferent loop A was observed. Perforation ‘P’ of strangulated bowel is also noted. (B) After the deflection of efferent loop ‘E’, reducted afferent loop ‘A’ with perforation ‘P’ from herniated site ‘H’ was well visualized.

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