{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:23Z","timestamp":1756339523533,"version":"3.44.0"},"reference-count":8,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,12,20]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>Afferent loop syndrome is a rare complication after gastrectomy with Billroth II or Roux-en-Y reconstruction, caused by an obstruction in the proximal loop. The biliary stasis and bacterial overgrowth secondary to this obstruction can lead to repeated episodes of acute cholangitis. We present the case of a male patient who had previously undergone gastrectomy with Roux-en-Y reconstruction and later experienced multiple episodes of acute cholangitis secondary to choledocolithiasis. He underwent an open exploration of the bile ducts with choledocolitotomy, but the events of cholangitis persisted. Further investigation permitted to identify a dilation of the biliary loop of the Roux-en-Y anastomosis, suggesting enterobiliary reflux as the cause of recurrent acute cholangitis. Therefore, a bowel enterectomy and new jejunojejunostomy were undertaken, and normal biliary flow was re-established. The surgical treatment is mandatory in benign causes, leading to the resolution of the obstruction and subsequent normalisation of bile flow.<\/jats:p>","DOI":"10.1136\/bcr-2019-232498","type":"journal-article","created":{"date-parts":[[2020,1,6]],"date-time":"2020-01-06T07:49:23Z","timestamp":1578296963000},"page":"e232498","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Management of afferent loop syndrome after Roux-en-Y subtotal gastrectomy and choledocolithiasis with recurrent cholangitis"],"prefix":"10.1136","volume":"13","author":[{"given":"Fernando","family":"Azevedo","sequence":"first","affiliation":[{"name":"General Surgery, Hospital and University Centre of Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Canhoto","sequence":"additional","affiliation":[{"name":"General Surgery, Hospital and University Centre of Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Guilherme","family":"Tralh\u00e3o","sequence":"additional","affiliation":[{"name":"General Surgery, Hospital and University Centre of Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e9lder","family":"Carvalho","sequence":"additional","affiliation":[{"name":"General Surgery, Hospital and University Centre of Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,1,5]]},"reference":[{"key":"2025082709121102000_13.1.e232498.1","doi-asserted-by":"crossref","first-page":"426","DOI":"10.9738\/INTSURG-D-13-00243.1","article-title":"Recurrent cholangitis by biliary stasis due to non-obstructive afferent loop syndrome after pylorus-preserving pancreatoduodenectomy: report of a case","volume":"99","author":"Sanada","year":"2014","journal-title":"Int Surg"},{"key":"2025082709121102000_13.1.e232498.2","first-page":"1","article-title":"Afferent loop syndrome after Roux-en-Y total gastrectomy caused by volvulus of the Roux-Limb","volume":"2016","author":"Katagiri","year":"2016","journal-title":"Case Rep Surg"},{"key":"2025082709121102000_13.1.e232498.3","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4512"},{"key":"2025082709121102000_13.1.e232498.4","doi-asserted-by":"crossref","first-page":"2389","DOI":"10.1007\/s00268-010-0602-5","article-title":"Afferent loop obstruction after distal gastrectomy with Roux-en-Y reconstruction","volume":"34","author":"Aoki","year":"2010","journal-title":"World J Surg"},{"key":"2025082709121102000_13.1.e232498.5","doi-asserted-by":"publisher","DOI":"10.1381\/096089203765887831"},{"key":"2025082709121102000_13.1.e232498.6","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000216285.07069.fc"},{"key":"2025082709121102000_13.1.e232498.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.1999.01092.x"},{"key":"2025082709121102000_13.1.e232498.8","doi-asserted-by":"crossref","DOI":"10.4076\/1757-1626-2-6339","article-title":"Acute cholangitis due to afferent loop syndrome after a Whipple procedure: a case report","volume":"2","author":"Spiliotis","year":"2009","journal-title":"Cases J"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-232498","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:12:17Z","timestamp":1756311137000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-232498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,1,5]]},"published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1136\/bcr-2019-232498"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-232498","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,1]]}}}