Technetium-99m HIDA hepatobiliary scanning in evaluation of afferent loop syndrome.

A study of 118 patients, operated on with Billroth II gastrectomy for peptic disease and affected by postgastrectomy syndromes, was carried out. Fifty patients were investigated by means of technetium-99m HIDA hepatobiliary scanning. In 18 patients, in whom an afferent loop syndrome was clinically suspected, hepatobiliary scanning demonstrated an altered afferent loop emptying in 8 and atonic distension of the gallbladder without afferent loop motility changes in 10. Among the patients in the first group, four were treated with a biliary diversion surgical procedure and in the second group, two patients underwent cholecystectomy. Our findings indicate that biliary vomiting, right upper abdominal pain pyrosis, and biliary diarrhea in Billroth II gastrectomized patients are not always pathognomonic symptoms of afferent loop syndrome. Technetium-99m HIDA hepatobiliary scanning represents the only diagnostic means of afferent loop syndrome definition. A differential diagnosis of abnormal afferent loop emptying and gallbladder dyskinesia is necessary for the management planning of these patients, and furthermore, when a surgical treatment is required, biliary diversion with Roux-Y anastomosis or Braun's biliary diversion seems the treatment of choice for afferent loop syndrome, whereas cholecystectomy represents the best procedure for atonic distension of the gallbladder.
AuthorsR Sivelli, A M Farinon, M Sianesi, M Percudani, G Ugolotti, B Calbiani
JournalAmerican journal of surgery (Am J Surg) Vol. 148 Issue 2 Pg. 262-5 (Aug 1984) ISSN: 0002-9610 [Print] UNITED STATES
PMID6465434 (Publication Type: Journal Article)
Chemical References
  • Imino Acids
  • Technetium Tc 99m Lidofenin
  • Technetium
  • Adult
  • Afferent Loop Syndrome (classification, radionuclide imaging, therapy)
  • Aged
  • Biliary Dyskinesia (diagnosis)
  • Biliary Tract (radionuclide imaging)
  • Cholecystectomy
  • Diagnosis, Differential
  • Female
  • Gastrectomy
  • Humans
  • Imino Acids
  • Liver (radionuclide imaging)
  • Male
  • Middle Aged
  • Peptic Ulcer (surgery)
  • Technetium
  • Technetium Tc 99m Lidofenin
  • Time Factors

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