Three months after a Billroth II gastrectomy, a patient develops severe colicky upper abdominal pain with bilious vomiting that relieves the pain, occurring 30 minutes after meals. What is the diagnosis?

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

Explanation

In afferent loop syndrome the afferent limb carrying bile and pancreatic juice becomes obstructed, classically by kinking or internal herniation after Billroth II. Secretion raises intraluminal pressure causing colicky pain, and forceful bilious vomiting decompresses the loop and relieves pain. Alkaline reflux gastritis causes continuous burning epigastric pain worsened by vomiting rather than relieved by it. Treatment is conversion to a 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.