Gastric jejunal afferent loop syndrome

　　It is often related to low tension, overlong twisting of the input loop, or obstruction of the output loop, causing duodenal emptying to be blocked. It usually occurs within 24 hours after surgery, but can also occur several days or even years later. The obstruction can be partial or complete, intermittent or permanent. Approximately 1% of patients after Billroth II surgery may experience obstruction at the site where the input loop approaches the gastrojejunal area. Among them, the anterior colonic anastomosis is more common than the posterior colonic anastomosis. During the anterior colonic anastomosis, due to the overly long input loop, it can become strangulated when passing through the gap between the mesentery of the jejunal output loop and the transverse colon mesentery.

　　Gastrojejunal input loop syndrome secondary to gastrojejunal anastomosis often occurs with gastric or jejunal diseases, such as acute peritonitis, intestinal obstruction, shock, etc. In patients with chronic input loop syndrome, the duodenum and jejunal input loops can significantly dilate, and a mass can be palpated in the abdomen.

　　What are the symptoms of gastrojejunal input loop syndrome? Briefly described as follows:

　　1. Acute jejunal input loop obstruction.Sudden severe upper abdominal pain, frequent vomiting, without bile in the vomit, and symptoms do not subside after vomiting; in severe cases, duodenal dilatation, intestinal wall necrosis, and perforation may occur, leading to acute peritonitis.

　　2. Chronic input loop syndrome.Uncomfortable upper abdominal pain and distension, sudden vomiting of a large amount of bile, and the symptoms can be relieved.

　　The prevention of this disease mainly lies in paying attention to the details of the operation during the gastrojejunostomy, such as the adhesion of the input loop and the suture site. Some scholars have observed that the incidence of the proximal small curvature to the large curvature is high during anastomosis, so it is advisable to use the proximal large curvature, which is related to the angle of the anastomosis. During gastrointestinal anastomosis, the angle between the anastomosis and the midline of the abdomen (parallel line) should be ≥45°. An angle less than this is prone to form an entrance obstruction. When closing the mesenteric opening of the posterior colonic anastomosis, the fixed suture is placed on the gastric wall above the anastomosis. Regarding the length of the entering loop, some believe that the shorter the better, as it is easier to form an angle. The length before the colon should not be less than 15cm, and the length after the colon should not be more than 12cm. The ideal length of the jejunum after anastomosis is to overcome the traction force of the stomach.

　　What examinations should be done for gastric jejunoileal bypass syndrome? Briefly described as follows:

　　1. Physical examination.Acute jejunoileal bypass obstruction: upper abdominal tenderness, palpable suspicious mass or dilated intestinal loop, followed by increased heart rate, decreased blood pressure, and other shock symptoms. Chronic jejunoileal bypass syndrome: long-term patients, the duodenum and jejunoileal bypass can be significantly dilated, and a mass can be palpated in the abdomen.

　　2. X-ray examination.Abdominal flat film shows dilated intestinal loops in the upper right abdomen, with a large liquid level.

　　3. Barium meal examination.Barium meal examination can prove that the duodenum and the jejunoileal bypass are in a giant dilated state.

　　What should be paid attention to in the dietary care of patients with gastric jejunoileal bypass syndrome? Briefly described as follows.

　　1. Semi-liquid foods suitable for patients with this disease: minced meat congee, chopped vegetable congee, egg flower congee, noodle soup, noodle slice soup, wonton, bread, steamed egg custard, egg flower soup, boiled eggs, milk, yogurt, soft tofu, tofu pudding.

　　1. Foods to avoid: beans, soybeans, large vegetables, large amounts of meat, steamed dumplings, etc. should not be eaten; fried foods such as smoked fish, fried meatballs, etc. should also not be eaten; hard and difficult-to-digest foods such as steamed rice and pancakes should be eaten less or not at all; spicy seasonings and the like should also not be eaten.

　　What are the treatment methods for gastric jejunoileal bypass syndrome? Briefly described as follows:

　　1. Acute Jejunoileal Bypass Obstruction

　　Acute jejunoileal bypass obstruction should be operated on promptly to relieve the obstruction and perform jejunoileal bypass side-to-side anastomosis.

　　2. Chronic Jejunoileal Bypass Syndrome

　　The obstruction is not severe and can be relieved by adjusting the body position (lying on the right side), applying anti-inflammatory and anti-swelling drugs. The symptoms can be relieved. Complete treatment still requires scheduled surgery.