A 60-year-old man presents 2 years after Billroth II gastrojejunostomy with episodic postprandial right upper quadrant pain followed by bilious vomiting that relieves his symptoms. He has no fever or weight loss. What is the underlying mechanism?
- A Obstruction of the efferent jejunal limb
- B Gastric remnant carcinoma
- C Accumulation of biliopancreatic secretions in the afferent limb ✓
- D Marginal ulceration at the anastomosis
Correct answer: C. Accumulation of biliopancreatic secretions in the afferent limb
Explanation
Afferent loop syndrome results from partial obstruction of the afferent limb, causing accumulation of bile and pancreatic secretions. After meals, increased secretion distends the loop causing pain, followed by forceful bilious vomiting with relief. Efferent limb obstruction causes vomiting of food mixed with bile without the same relief pattern. Marginal ulcer causes epigastric pain unrelated to bilious vomiting.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.