Three years after a Billroth II gastrectomy, a 58-year-old man develops colicky right upper quadrant abdominal pain that builds up over 20 minutes and is then suddenly relieved by the projectile vomiting of a large volume of bilious fluid containing no food particles. What is the diagnosis?

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

Explanation

In afferent loop syndrome the afferent limb carrying bile and pancreatic juice becomes obstructed; secretions accumulate causing colicky pain, and decompression occurs when the pressure forces a gush of pure bile into the stomach, classically relieving the pain. In efferent loop obstruction the vomitus contains both food and bile and does not relieve the pain. Alkaline reflux gastritis causes continuous bilious vomiting with epigastric burning rather than colicky pain relieved by vomiting.

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

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Written and medically reviewed by the StethoPrep medical team.