Conter R L, Converse J O, McGarrity T J, Koch K L
Department of Surgery, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey 17033.
Surgery. 1990 Jul;108(1):22-7.
Afferent loop obstruction after gastrectomy and Billroth II reconstruction is an uncommon problem. Complete acute obstruction requires emergent laparotomy. However, chronic obstruction may begin insidiously and its symptoms may reflect other gastrointestinal diseases. Two patients are described who developed acute abdominal pain, marked hyperamylasemia, and palpable abdominal masses 5 and 15 years after Billroth II gastrectomy. The masses were initially interpreted as pancreatic pseudocysts. Both patients were found to have chronically obstructed afferent limbs, and in one the obstruction was associated with hundreds of stasis stones within the afferent limb. Surgical decompression was accomplished in each patient. Patients who have undergone Billroth II reconstruction have signs, symptoms, and laboratory findings consistent with acute pancreatitis. A history of previous gastrectomy, recurrent or severe abdominal pain, hyperamylasemia with characteristic tomography, and endoscopic findings will establish the diagnosis and necessitate surgical evaluation and intervention.
胃切除术后行毕Ⅱ式重建出现输入袢梗阻是一个少见的问题。完全性急性梗阻需要紧急剖腹手术。然而，慢性梗阻可能起病隐匿，其症状可能与其他胃肠道疾病相似。本文描述了2例患者，在毕Ⅱ式胃切除术后5年和15年出现急性腹痛、显著的高淀粉酶血症及可触及的腹部肿块。肿块最初被误诊为胰腺假性囊肿。两名患者均被发现存在慢性输入袢梗阻，其中1例梗阻与输入袢内数百枚滞留结石有关。每位患者均接受了手术减压。接受毕Ⅱ式重建的患者出现与急性胰腺炎相符的体征、症状及实验室检查结果。既往胃切除术史、反复或严重的腹痛、具有特征性影像学表现的高淀粉酶血症以及内镜检查结果将有助于确立诊断，并需要进行手术评估和干预。
