The Consequences of Delayed Diagnosis of Acute Afferent Loop Syndrome

急性傳入腸曲症候群延遲診治之後果

胡順志(Shun-Chih Hu) ； 陳祖裕(Cho-Yu Chan) ； 李壽東(Shou-Dong Lee)

《中華民國消化系醫學會雜誌》 11卷2期 (1994/06) Pp. 125-130

https://doi.org/10.6557/GJTa.199406_11(2).0002

摘要

From February 1983 to February 1993, 28 cases of acute afferent loop syndrome (ALS) were admitted to our hospital. The diagnosis of nine cases (group 1) was delayed more than 24 hours between arrival and surgical intervention. In addition, each of these cases was initially misdiagnosed as having acute pancreatitis. The remaining 19 cases (group 2) received surgical intervention within 24 hrs. The initially clinical manifestations, including epigastric pain and vomiting, were similar in both groups (p＞0.05). However, fever was more common in group 1 (p＜0.0l). The laboratory data, including WBC, hemoglobin, platelet count, serum levels of bilirubin and liver enzymes, was not significantly different between the two groups (p＞0.05), except for significantly higher levels of serum amylase (3026±518 U/L vs 1312±157 U/L, p＜0.0l) shown by group 1. Only 2 patients in group 1 received early ultrasonography, in contrast with group 2 patients who all had an early ultrasonography and/or computed tomography (CT). The prevalence of intestinal perforation, sepsis and mortality was significantly higher in group 1 (100% vs 11%, 66.7% vs 5.3% and 66.7% vs 5.3%, p＜0.01). In conclusion, delayed diagnosis of acute ALS may lead to more severe morbidities and higher mortality rates. The reason for the delayed diagnosis is not because of an unusual manifestation of the disease, but more likely due to the inexperience of the clinical physicians. Therefore, emergent abdominal ultrasonography or CT is indicated for any patient with B- II gastrectomy who suffers from acute abdominal pain in association with high serum amylase levels.

關鍵字

傳入腸曲症候群 ； 胃切除術 ； 胰臟炎

並列摘要

From February 1983 to February 1993, 28 cases of acute afferent loop syndrome (ALS) were admitted to our hospital. The diagnosis of nine cases (group 1) was delayed more than 24 hours between arrival and surgical intervention. In addition, each of these cases was initially misdiagnosed as having acute pancreatitis. The remaining 19 cases (group 2) received surgical intervention within 24 hrs. The initially clinical manifestations, including epigastric pain and vomiting, were similar in both groups (p＞0.05). However, fever was more common in group 1 (p＜0.0l). The laboratory data, including WBC, hemoglobin, platelet count, serum levels of bilirubin and liver enzymes, was not significantly different between the two groups (p＞0.05), except for significantly higher levels of serum amylase (3026±518 U/L vs 1312±157 U/L, p＜0.0l) shown by group 1. Only 2 patients in group 1 received early ultrasonography, in contrast with group 2 patients who all had an early ultrasonography and/or computed tomography (CT). The prevalence of intestinal perforation, sepsis and mortality was significantly higher in group 1 (100% vs 11%, 66.7% vs 5.3% and 66.7% vs 5.3%, p＜0.01). In conclusion, delayed diagnosis of acute ALS may lead to more severe morbidities and higher mortality rates. The reason for the delayed diagnosis is not because of an unusual manifestation of the disease, but more likely due to the inexperience of the clinical physicians. Therefore, emergent abdominal ultrasonography or CT is indicated for any patient with B- II gastrectomy who suffers from acute abdominal pain in association with high serum amylase levels.

並列關鍵字

afferent loop syndrome ； gastrectomy ； pancreatitis