RECURRENT ACUTE-PANCREATITIS CAUSED BY AFFERENT LOOP STRICTURE AFTER GASTRECTOMY

Afferent loop obstruction after gastrectomy and Billroth II gastrojeju nostomy is only rarely diagnosed as the cause of recurrent acute pancr eatitis. Three patients are described in whom afferent loop stricture after gastrectomy and Billroth II reconstruction manifested as recurre nt pancreatitis 13 to 24 years after the initial procedure. Late onset , nonspecific symptoms, and other simultaneous gastrointestinal pathol ogic features promoted a chronic clinical course in all patients. Symp toms included acute abdominal pain, vomiting, jaundice, hyperamylasemi a, weight loss, and anemia. A thorough history, barium examination, ch olescintigraphy, and endoscopy were central in establishing the diagno sis. The pathogenesis of stricture formation is thought to be ischemic mucosal damage from intestinal crossclamping. Surgical decompression provided lasting relief of the symptoms. Afferent loop stricture shoul d be considered in the differential diagnosis in patients with recurre nt acute pancreatitis and previous gastrectomy with Billroth II recons truction.