Afferent loop obstruction after gastric cancer surgery: helical CT findings

Background: We reviewed the computed tomographic (CT) findings of afferent loop obstruction and assessed the value of helical CT in determining the underlying cause.Methods: Helical CT scans of 18 patients (12 men and six women; age range = 35–67, mean age = 50 years) with afferent loop obstruction were reviewed. All patients had gastric cancer. Ten patients had undergone radical subtotal gastrectomy with Billroth II gastrojejunostomy, and eight had undergone total gastrectomy with Roux-en-Y esophagojejunostomy. CT images were analyzed retrospectively, and the presumed cause of obstruction on CT was compared with surgical findings (n = 8) and clinical courses (n = 10).Results: Local recurrence (n = 15), peritoneal seeding (n = 1), internal hernia (n = 1), and adhesion (n = 1) were the presumed causes of obstruction on CT. In all eight patients who underwent a second operation, the cause of afferent loop obstruction was correctly suggested on CT (local recurrence in six patients and adhesion and internal hernia in one patient). In 10 patients who were not re-explored, the clinical findings or biopsy indicated recurrent tumor as suggested on CT.Conclusion: Recurrent tumors and other potential causes of afferent loop obstruction can be correctly predicted with CT in most cases.