After Billroth II gastrectomy, a patient develops bile vomiting relieved by food, bilious aspirates, and abdominal pain — worse in the morning. The most likely diagnosis is:

• A Afferent loop syndrome ✓
• B Efferent loop obstruction
• C Dumping syndrome
• D Alkaline reflux gastritis

Explanation

Afferent loop syndrome occurs when the afferent limb (carrying bile and pancreatic juice) after Billroth II is kinked or obstructed, causing accumulation of secretions. Characteristic features: bilious vomiting that relieves the pain (decompression of distended afferent loop), episodic postprandial pain, and symptoms worse when lying down. Alkaline reflux gastritis causes constant bile vomiting unrelated to food. Efferent loop obstruction causes obstipation and abdominal distension rather than bile vomiting that relieves pain.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.