A Rare Cause of Afferent Loop Syndrome

A 47-year-old female underwent robotic pancreatoduodenectomy for the pancreatic head cancer. During surgery, jejunum (the afferent limb) was brought up, although Treitz ligament route to perform pancreaticojejunostomy and hepaticojejunostomy anastomoses, followed by antecolic gastrojejunostomy. The patient presented with acute abdominal pain 3 months after surgery. Laboratory found elevated hepato-pancreato-biliary enzymes: Total bilirubin, 2.0 mg/dL; aspartate aminotransferase, 650 U/L; alanine 406 amylase, 178 U/L. Computed tomography showed swollen loop (Figure A). Double-balloon enteroscopy performed treatment revealed closed due limb volvulus B Figure C), which successfully repositioned endoscopic intervention D). up without recurrence of syndrome a few months. Afferent is rare complication following gastrectomy Billroth II or Roux-en-Y reconstruction. To best our knowledge, this first report demonstrate pancreatoduodenectomy. Diagnostic therapeutic can be option. Next, surgical should considered in complicated cases refractory intervention.