Síndrome da alça aferente com necrose simulando pseudocisto de pâncreas

Afferent loop obstruction with necrosis presenting as pancreatic pseudocyst

Afferent loop obstruction; Pancreatitis

RELATOS DE CASOS

Síndrome da alça aferente com necrose simulando pseudocisto de pâncreas

Afferent loop obstruction with necrosis presenting as pancreatic pseudocyst

Gerson Alves Pereira^I; Omar Féres, ACBC-SP^I; José Ivan de Andrade, TCBC-SP^II; Reginaldo Ceneviva, TCBC-SP^III

^IMédico Assistente do Serviço de Cirurgia da Unidade de Emergência do Hospital das Clínicas da FMRP-USP

^IIProfessor Doutor do Departamento de Cirurgia, Ortopedia e Traumatologia (DCOT) da FMRP-USP. Coordenador do Serviço de Cirurgia

^IIIProfessor Titular do DCOT da FMRP-USP

^{Endereço para correspondência}

ABSTRACT

Afferent loop obstruction after gastrectomy and Billroth II reconstruction is an uncommon problem. Complete acute obstruction requires emergent laparotomy. We describe a patient who developed acute abdominal pain, hyperamylasemia, and palpable abdominal mass, five years after Billroth II gastrectomy. At laparotomy the patient was found to have a complete stricture of the afferent limb with evidence of strangulation and necrosis. There was no evidence of pancreatitis or pancreatic pseudocyst. The patient underwent pancreaticoduodenectomy plus degastrectomy and died 18 hours after the procedure in the ICU. The mass was initially inte1preted as pancreatic pseudocyst. Ultrasonography may provide enough evidence to differentiate a pancreatic pseudocyst. from an obstructed afferent loop, by the presence of a peripancreatic cystic mass or debris within the mass or the absence of the keyboard sign, suggesting effacement of the valvulae conniventes of the small bowel. Howewer, CT scan of the abdomen has been suggested to be highly characteristic, if not pathognomonic, for an obstructed afferent loop and should be considered first in patients with pancreatitis after Billroth II gastrectomy. A history of previous gastrectomy, recurrent or severe abdominal pain, hyperamylasemia with characteristic tomography, and endoscopic findings will establish the diagnosis and necessitate surgical evaluation and intervention.

Key words: Afferent loop obstruction; Pancreatitis.

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Recebido em 23/5/97

Aceito para publicação em 6/11/97

Trabalho realizado no Serviço de Cirurgia da Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - FMRP-USP.

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• ⁴
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Endereço para correspondência:

Dr. Omar Féres

Rua João Penteado, 989

14025-010 - Ribeirão Preto - SP

Datas de Publicação

• Publicação nesta coleção
  05 Ago 2010
• Data do Fascículo
  Abr 1998

Histórico

• Recebido
  23 Maio 1997
• Aceito
  06 Nov 1997