Management of afferent loop obstruction

Posted on April 28, 2025 by John

“Afferent loop obstruction is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. The operations most commonly associated with this complication are gastrectomy with Billroth II or Roux-en-Y reconstruction, and
pancreaticoduodenectomy with conventional loop or Roux-en-Y reconstruction. Etiology of afferent loop obstruction includes:
(1) entrapment, compression and kinking by postoperative adhesions
(2) internal herniation, volvulus and intussusception
(3) stenosis due to ulceration at the gastrojejunostomy site and radiation enteritis of the afferent loop
(4) cancer recurrence
(5) enteroliths, bezoars and foreign bodies.

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Stomal necrosis

Posted on March 12, 2020 by E. Lawson

Murken DR, Bleier JIS. Ostomy-Related Complications. Clin Colon Rectal Surg. 2019 May;32(3):176-182.

Full-text for Emory users.

“Stomal necrosis has been reported to occur in up to 20% of ostomates in the immediate postoperative period ([Fig. 1]).[3] Specific risk factors for stoma necrosis include emergent operation, inadequate mobilization of the bowel, excessive mesenteric resection resulting in inadequate arterial blood supply to or venous drainage from the bowel, and constriction in the abdominal wall due to excessively small openings in the fascia, abdominal wall mesh, or skin.[10] [20] Importantly, the obese patient is seven times more likely to experience stoma necrosis than the nonobese patient.[21] Stoma necrosis is much less common for loop stomas given the dual blood supply to both the afferent and efferent limbs.”

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