Mithöfer K, Warshaw A L
Department of Surgery, Massachusetts General Hospital, Boston, USA.
Arch Surg. 1996 May;131(5):561-5. doi: 10.1001/archsurg.1996.01430170107021.
Afferent loop obstruction after gastrectomy and Billroth II gastrojejunostomy is only rarely diagnosed as the cause of recurrent acute pancreatitis. Three patients are described in whom afferent loop stricture after gastrectomy and Billroth II reconstruction manifested as recurrent pancreatitis 13 to 24 years after the initial procedure. Late onset, nonspecific symptoms, and other simultaneous gastrointestinal pathologic features promoted a chronic clinical course in all patients. Symptoms included acute abdominal pain, vomiting, jaundice, hyperamylasemia, weight loss, and anemia. A thorough history, barium examination, cholescintigraphy, and endoscopy were central in establishing the diagnosis. 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 should be considered in the different diagnosis in patients with recurrent acute pancreatitis and previous gastrectomy with Billroth II reconstruction.
胃切除术后和毕Ⅱ式胃空肠吻合术后输入袢梗阻很少被诊断为复发性急性胰腺炎的病因。本文描述了3例患者，他们在接受胃切除术后和毕Ⅱ式重建术后出现输入袢狭窄，表现为初次手术后13至24年的复发性胰腺炎。发病较晚、症状不典型以及同时存在的其他胃肠道病理特征导致所有患者的临床病程呈慢性。症状包括急性腹痛、呕吐、黄疸、高淀粉酶血症、体重减轻和贫血。详尽的病史、钡剂检查、胆系闪烁显像和内镜检查对确诊至关重要。狭窄形成的发病机制被认为是肠钳夹导致的缺血性黏膜损伤。手术减压可使症状得到持久缓解。对于复发性急性胰腺炎且既往有胃切除术和毕Ⅱ式重建术的患者，在鉴别诊断时应考虑输入袢狭窄。
