AFFERENT & EFFERENT

LOOP SYNDROME

Batasan
Sindroma akibat obstruksi mekanik lengkap atau parsial
pada titik di sepanjang bagian jejunum loop aferen atau
eferen post Gastrojejunostomy
Komplikasi murni mekanis akibat tindakan
gastrojejunostomy yang jarang terjadi
Tanda dan gejala dari kedua komplikasi sulit dibedakan

Efferent
Loop

Etiologi
Entrapment or compression of the afferent loop by
postoperative adhesions
Internal hernia (eg, through a mesocolic defect)
Volvulus of the intestinal segment
Enteroenteral or enterogastric intussusception
Terbelitnya afferent limb pada gastrojejunostomy

 Scarring due to marginal (stomal) ulceration

Recurrence of cancer at or near the anastomotic site
Enteroliths in the afferent limb
Foreign bodies in the afferent limb or at the
anastomosis

Patofisiologi
obstruksi mekanik lengkap atau parsial peningkatan tekanan
intraluminal dan distensi akibat akumulasi sekresi enteric
o Vomiting, abdominal pain, distensi usus
o ikterus obstruktif , kolangitis , dan pankreatitis karena tekanan tinggi
transmisi kembali ke sistem duktus biliopancreatic
o meningkatkan usus ketegangan dinding di lingkaran aferen ( sesuai
dengan hukum Laplace ) dan dapat menyebabkan iskemia dan gangren
perforasi dan peritonitis
o Prolonged stasis pertumbuhan bakteri yang berlebihan dalam
lingkaran aferen Bakteri deconjugate asam empedu steatorrhea ,
kekurangan gizi , dan B - 12 kekurangan vitamin menyebabkan anemia
megaloblastik

Pemeriksaan Fisik
Massa tidak jelas di kuadran abdomen kanan.
Localized midepigastric or right upper abdominal
quadrant tenderness
Peritonitis
Jaundice
Tanda-tanda pankreatitis

Laboratorium
Complete blood count
Anemia (hemoglobin and hematocrit), Infection or acute illness (WBC
count), and a possible cause for anemia related to ALS (eg, vitamin B-12 deficiency
anemia, iron deficiency anemia).
Liver function tests and pancreatic enzymes
Elevated levels of serum bilirubin, alkaline phosphatase, alanine
aminotransferase, aspartate aminotransferase, amylase, and lipase may be
detected when biliary tract obstruction is prominent.
Electrolyte panel
Serum electrolytes should be examined, especially in patients with
prolonged vomiting and possible dehydration. These conditions can lead to
hyponatremia or hypernatremia, hypokalemia, and hypochloremia. Metabolic
alkalosis may be present.

Radiologic

Afferent limb syndrome. Tracing of kinking of the afferent limb at the gastrojejunostomy.

Tatalaksana
Nasogastric tube drainage
Nutritional support atau transfusion sebelum
pembedahan
Surgical correction is effected by deconstructing the
Billroth II gastrojejunostomy and restoring
gastrointestinal continuity with an alternate method
Billroth I gastroduodenostomy and Roux-en-Y
gastrojejunostomy

Komplikasi
Wound infection
Wound dehiscence with
or without evisceration
Urinary tract infection
Atelectasis
Pneumonia
Anastomotic disruption
Anastomotic stricture
Marginal ulceration
Intra-abdominal
abscess formation
Cholangitis

Delayed gastric
emptying/gastroparesis
Internal or
enterocutaneous fistulae
Small bowel obstruction
Dumping syndrome
Alkaline reflux gastritis
Roux stasis syndrome
Cardiac arrhythmias
Deep venous thrombosis
Pulmonary embolism