Six weeks after a Billroth II gastrojejunostomy, a 50-year-old man develops colicky right upper quadrant abdominal pain followed by sudden projectile vomiting of large volumes of pure bile containing no food, after which the pain settles completely. Which complication explains these episodes?

• A Alkaline reflux gastritis from bile exposure of the gastric remnant
• B Afferent loop syndrome from partial obstruction of the afferent limb ✓
• C Late dumping syndrome from reactive hypoglycaemia
• D Efferent loop obstruction with retained food in the efferent limb

Explanation

Intermittent partial obstruction of the afferent limb traps biliary and pancreatic secretions, causing colicky pain and a distended loop that empties abruptly as bilious vomiting without food, relieving the pain. Efferent loop obstruction classically vomits food mixed with bile, and alkaline reflux gastritis causes continuous bilious vomiting with burning epigastric pain rather than cramping pain relieved by vomiting. Large afferent loops may require conversion to Roux-en-Y reconstruction.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.