A 55-year-old woman who underwent Billroth II gastrectomy five years ago presents with cramping upper abdominal pain occurring 30 minutes after meals, followed by sudden bilious vomiting that relieves the pain. She is not jaundiced. Abdominal X-ray during an episode shows a dilated proximal jejunal loop in the right upper quadrant. The most likely diagnosis is:
- A Early dumping syndrome
- B Afferent loop syndrome ✓
- C Alkaline reflux gastritis
- D Roux stasis syndrome
Correct answer: B. Afferent loop syndrome
Explanation
In afferent loop syndrome after Billroth II, the afferent limb carrying bile and pancreatic juice becomes obstructed, fills after meals, distends, and causes colicky right upper quadrant pain that is characteristically relieved by projectile bilious vomiting which decompresses the loop. Early dumping occurs within 30 minutes but features vasomotor symptoms without pain-relieving bilious vomiting. Alkaline reflux gastritis causes constant burning pain worsened by vomiting, not relieved by it. Roux stasis applies to Roux-en-Y reconstructions, not Billroth II.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.