Li Hao, Sun Yucheng, Wang Zhenyu, Ji Zixiang, Xu Junqiang, Cui Fengzhe
Department of General Surgery, Affiliated Hospital of Yanbian University, Yanji, P.R. China.
Department of General Surgery, Dunhua People's Hospital, Dunhua, P.R. China.
SAGE Open Med Case Rep. 2022 Feb 21;10:2050313X221078723. doi: 10.1177/2050313X221078723. eCollection 2022.
Afferent loop (A-loop) obstruction presenting as acute pancreatitis is a rare clinical entity. We report a case of A-loop obstruction that occurred 15 years after Billroth II gastrectomy, leading to acute pancreatitis and accompanied by duodenal perforation and peritonitis. A 63-year-old man complaining of upper abdominal pain, distention, and nausea was referred to our hospital. The patient was previously treated with antibiotics and gastrointestinal decompression at the primary healthcare institute after being diagnosed with acute pancreatitis. However, the symptoms did not improve. Upon inter-hospital transportation, he experienced a period of relief from the pain but soon developed signs of diffuse peritonitis. Laboratory examination showed elevated serum amylase and lipase. A computed tomography scan revealed slight edema of the pancreas, a dilated and fluid-filled bowel loop across the mid-abdomen, and fluid accumulation in the abdominal cavity and pelvis. An emergency laparotomy was conducted, followed by symptomatic treatments. The patient had an uneventful recovery and was discharged in 4 weeks.
以急性胰腺炎形式出现的输入袢（A袢）梗阻是一种罕见的临床病症。我们报告一例在毕Ⅱ式胃切除术后15年发生的A袢梗阻病例，该病例导致急性胰腺炎，并伴有十二指肠穿孔和腹膜炎。一名63岁男性因上腹部疼痛、腹胀和恶心被转诊至我院。该患者在被诊断为急性胰腺炎后，曾在基层医疗机构接受抗生素治疗和胃肠减压。然而，症状并未改善。在院际转运过程中，他曾有一段时间疼痛缓解，但很快出现弥漫性腹膜炎体征。实验室检查显示血清淀粉酶和脂肪酶升高。计算机断层扫描显示胰腺轻度水肿、中腹部肠袢扩张且充满液体，以及腹腔和盆腔积液。进行了急诊剖腹手术，随后进行了对症治疗。患者恢复顺利，4周后出院。
