A 55-year-old man who underwent truncal vagotomy with gastrojejunostomy two years earlier now presents with colicky upper abdominal pain, bilious vomiting containing food particles, and visible peristalsis across the epigastrium. Symptoms are relieved after vomiting large volumes of bile-stained fluid. What is the diagnosis?

• A Efferent loop obstruction
• B Afferent loop syndrome ✓
• C Alkaline reflux gastritis
• D Post-vagotomy diarrhea

Explanation

In afferent loop syndrome following Billroth II reconstruction, the afferent limb delivering bile and pancreatic juice becomes obstructed, causing distension, colicky pain, and eventual forceful bilious vomiting that relieves the pain. Vomiting bile mixed with old food suggests efferent loop obstruction, whereas pure bilious vomiting without food occurs in afferent loop blockage. Alkaline reflux gastritis causes continuous burning epigastric pain worsened by eating, without colicky distension.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.