Partial gastrectomy and reconstruction huntlawrence pouch for esophagojejunostomy roux en y gastric bypass afferent and efferent loop obstruction afferent and efferent loops reoperation for afferent loop syndrome schematic drawing of jejunogastric intussusception. Afferent loop syndrome als is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. Afferent nerve fibers refer to axonal projections that arrive at a particular brain region, as opposed to efferent projections that exit the region. Creation of an anastomosis between the stomach and jejunum leaves a segment of the small bowel, most commonly consisting of the duodenum and proximal jejunum, lying upstream from the gastrojejunostomy. Definition of afferent, efferent, roux limbs student doctor. The efferentloop syndrome in a narrow sense refers only to obstruction of the efferent jejunal loop after gastric resection or simple gastroenterostomy.
Efferent loop syndrome is one of two loop syndromes that can happen after some types of gastric surgery. Whipple procedures are mainly used to treat patients with pancreatic head and periampullary tumors as well as for those with chronic pain syndrome. During the procedure, a surgeon will remove or bypass the lower part of the stomach and attach the remaining upper part of the stomach to a loop of small. B differentiation between afferent and efferent loops is only possible when contrast is seen to pass distally white arrow. The efferent limb extends downstream through the distal jejunum and on down towards the cecum. Treatment by means of the placement of dual stents.
Afferent loop syndrome after whipple procedure sages. The efferent loop syndrome in a narrow sense refers only to obstruction of the efferent jejunal loop after gastric resection or simple gastroenterostomy. Afferent loop syndrome is a mechanical bowel obstruction internal hernia, volvulus, stricturing, etc that results in an effective biliary outlet obstruction. When efferent loop syndrome happens, it is usually within the first few weeks after gastric bypass surgery. Afferent loop syndrome is a rare entity that may be the cause of abdominal pain, nausea and vomiting in patients who have had a gastrojejunostomy and is diagnosed primarily by clinical suspicion. Afferent data flow is the incoming data flow in a sequential set of process bubbles.
Creation of an anastomosis between the stomach and jejunum leaves a segment of small bowel, most commonly consisting of duodenum and proximal jejunum, lying upstream from the gastrojejunostomy. Afferent loop syndrome has been defined as an acute or chronic mechanical obstruction of the afferent limb following subtotal gastrectomy with billroth ii anastomosis or duodenojejunostomy following a pyloricpreserving whipple procedure. Afferent loop syndrome als is caused by mechanical obstruction of the afferent loop of a doublebarrel gastrojejunostomy a. The various methods used to reestablish gastroenteric continuity after subtotal gastrectomy still do not totally obviate unpleasant complications and sequelae.
Afferent loop syndrome after rouxeny total gastrectomy. Afferent loop syndrome can occur after some types of gastrojejunostomy. Pdf laparoscopy in afferent loop obstruction presenting as. Als may be surgically corrected by deconstructing the billroth ii gastrojejunostomy and restoring gastrointestinal continuity with a rouxeny gastrojejunostomy b. Afferent loop sydrome common after bilroth ii is characterized by post prandial ruq pain, bilious vomiting, anemia, steatorrhea, and pain which resolves suddenly after decompression. Efferent nerve fibers refer to axonal projections that exit a particular region. Rouxeny gastric bypass biliopancreatic diversion partial gastrectomy total gastrectomy partial pancreaticoduodenectomy whipple.
In efferent loop syndrome, a portion or limb of the small intestine becomes blocked. Learn vocabulary, terms, and more with flashcards, games, and other study tools. If your healthcare provider thinks you have efferent loop syndrome because of gastric bypass surgery, he or she may do a physical exam, upper gastrointestinal xray, or a ct scan to look for the blockage. Complications such as obstruction or dysfunction of the efferent jejunal loop, dumping syndrome, and to some extent, nutritional deficiencies appear to be inherent in the surgical rearrangement of the gastroenteric continuity. In a loop syndrome, a portion or limb of the small. Peripheral nervous system efferent division questions.
Afferent loop syndrome definition of afferent loop syndrome. Start studying peripheral nervous system efferent division. Afferent loop syndrome health encyclopedia university of. Afferent limb syndrome also called afferent loop syndrome is a complication following billroth ii gastrojejunostomy characterized by acute or chronic intermittent obstruction of the afferent jejunal limb. Acute als results from complete obstruction, usually occurs early after surgery and runs a devastatingly lethal course unless promptly treated by reoperation. The afferent pathway carries nerve impulses into the cns central nervous system from the pns and the efferent pathway carries nerve impulses from the cns to the pns peripheral nervous system. An obstruction of the afferent limb can present in various ways. What is the difference between afferent and efferent data flow. Afferent loop syndrome als is a purely mechanical complication that infrequently occurs following the construction of a gastrojejunostomy.
This article is from clinical endoscopy, volume 46. Avoid the mispronunciation eferent, sometimes adopted to. Afferent loop syndrome is a rare complication of gastric surgery. He had a history of total gastrectomy with a rouxeny reconstruction.
Afferent loop syndrome after rouxeny total gastrectomy caused. Surgeons have improved gastric surgery, so both types of. Blind loop syndrome bls, also known as stagnant loop syndrome, is a state that occurs when the normal bacterial flora of the small intestine proliferates to numbers that cause significant derangement to the normal physiological processes of digestion and absorption. The clear differentiation between the afferent loop syndrome als and the other postgastrectomy syndromes was made by hoffmann 3. Endoscopic treatment of efferent loop syndrome with. The excellent results which followed a double jejunal loop interposition in another patient who was vomiting small amounts of bile each day 1 seemed to warrant employment of a similar procedure 2,3 in the surgical management in the case which we. Efferent loop syndrome is one of two loop syndromes. Afferent loop syndrome definition of afferent loop. The key difference between afferent and efferent arterioles is, the afferent arterioles bring the impure blood to the glomerulus whereas the efferent arterioles take away the pure filtered blood back to the circulatory system. This is a result from a complete blockage that commonly happens early after the surgical procedure and can be very dangerous unless prompt reoperation. These terms have a slightly different meaning in the context of the peripheral nervous system pns and central nervous system cns in the pns, afferent and efferent projections are always from the perspective of the spinal cord see figures. Acute obstruction occurs within the first week after surgery. The afferent loop syndromes result from obstruction to the afferent jejunal loop.
In the chronic syndrome, shortening of the afferent loop to 1015 cm or conversion to either billroth i or rouxeny gastrojejunostomy will treat the condition. Efferent loop syndrome health encyclopedia university of. Difference between afferent and efferent arterioles compare. A roux limb may be formed in multiple different gastrointestinal surgeries, including bariatric surgery, e. Symptoms depend on which type of afferent loop syndrome is present. Call your healthcare provider right away if you have symptoms of efferent loop syndrome any time after your weightloss surgery. Afferent loop syndrome definition, symptoms, causes. Efferent data flow is the outgoing data flow from a sequential set of process bubbles. The efferent fiber is a long process projecting far from the neurons body that carries nerve impulses away from the.
The other type of loop syndrome is afferent loop syndrome. Complications such as obstruction or dysfunction of the efferent jejunal loop, dumping syndrome, and to some extent, nutritional. Ct diagnosis of afferent loop syndrome request pdf. Efferent loop syndrome is a very rare postgastrectomy syndrome that can occur following billrothii or rouxeny reconstruction. However, the efferent loop was still unobstructed figure 2. Case report afferent loop syndrome after rouxeny total. Afferent loop syndrome health encyclopedia university. A fluoroscopic image shows complex stricture at bilioenteric anastomosis black arrow extending into afferent white arrow and blind loop arrowhead. Get a printable copy pdf file of the complete article 541k. The loop carrying food away from the stomach is called the efferent loop. The lancet original articles the afferent loop syndrome bilious regurgitation after subtotal gastrectomy and its relief charlesa. Endoscopic treatment of efferent loop syndrome with insertion. Jul 31, 2016 afferent loop syndrome has been defined as an acute or chronic mechanical obstruction of the afferent limb following subtotal gastrectomy with billroth ii anastomosis or duodenojejunostomy following a pyloricpreserving whipple procedure. This class would have a high efferent coupling because it depends on the engine, wheel and body types.
The clear differentiation between the afferent loop syndrome als and the other postgastrectomy syndromes was made by hoffmann 3, who described the clinical picture as follows. Pdf afferent loop syndrome after rouxeny total gastrectomy. We report the successful treatment of a patient with efferent loop syndrome by implantation of a double pigtail stent. Causes of afferent loop syndrome include a kinking and angulation of the afferent limb, b internal. Afferent loop syndrome radiology reference article. Abstractafferent loop obstruction caused by enterolith formation is rare and cannot be easily treated with. These terms have a slightly different meaning in the context of the peripheral nervous system pns and central nervous system cns. All aimed at helping you enjoy life by being aware of how to care for your health. Barium studies suggest the diagnosis of afferent loop syndrome if the afferent loop does not fill, but it should be noted that up to 20% of unobstructed afferent loops will not fill during a. In a loop syndrome, part of the small intestine becomes blocked. One of the possible questions on our exam is, when is efferent.
May 15, 2019 afferent loop syndrome als is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. Efferent loop syndrome health encyclopedia university. Whereas the type wheel would have a high ca afferent coupling if several other packages depended on it car, plane, bicycle. Afferent loop syndrome is an intermittent partial or complete mechanical obstruction of the afferent limb of a gastrojejunostomy the syndrome classically refers to obstruction of the upstream limb of a sidetoside gastrojejunostomy but has also been used to refer to the biliopancreatic limb of a rouxeny gastrojejunostomy. A 73yearold man presented with one day of persistent abdominal pain, gradually radiating to the back. Dec 07, 2017 an efferent arteriole is a part of the renal artery that carries filtered pure blood back to the circulatory system. In the following decades several authors were able clearly to demonstrate that bile reflux into the stomach causes vomiting. Causes include jejunal herniation, intussusception, kinking, volvulus, marginal ulceration, paraanastomotic stenosis, and adhesion formation.
Percutaneous cholangioscopic lithotripsy for afferent loop. Abdominal computed tomography scan revealed dilation of the duodenum and small intestine. The efferentloop syndrome in a narrow sense refers only to obstruction of the efferent jejunal loop after gastric resection. Carrying inward to a central organ or section, as nerves that conduct impulses from the periphery of the body to the brain or spinal cord. Stay up to date with the latest health news and useful resources.
Efferent definition of efferent by medical dictionary. For example, an artery is an efferent vessel that carries blood away from the heart, and an efferent nerve carries impulses away from the central nervous system. Acute obstruction of afferent or efferent loop, following antacolic partial gastrectomy, with report of three cases. Reoperation is not common but often warranted for afferent and efferent loop syndromes and bile reflux gastritis. Efferent definition of efferent by the free dictionary. Sensory neurones receive an impulse that is generat. The loop going to the upper stomach is the afferent loop. Acute obstruction of afferent or efferent loop, following.
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