Acute Necrotizing Pancreatitis Secondary to Adhesive Afferent Loop Syndrome Six Years After Total Gastrectomy With Roux-en-Y Reconstruction: A Case Report.

Acute pancreatitis is an uncommon presentation of afferent loop syndrome, and progression to necrotizing pancreatitis is rarely described in the literature. A 65-year-old man presented with severe epigastric pain, nausea, and bilious vomiting six years after total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma. Laboratory tests showed marked elevations of amylase and lipase. Initial contrast-enhanced computed tomography (CT) demonstrated afferent loop obstruction with focal pancreatic hypoenhancement. Repeat CT performed approximately 72 hours after symptom onset confirmed progression to necrotizing pancreatitis. Emergency exploratory laparotomy identified an adhesive band causing mechanical obstruction of the afferent limb, and adhesiolysis successfully restored intestinal transit. The patient recovered uneventfully, with progressive clinical and laboratory improvement, and remained asymptomatic at the six-month follow-up. This case highlights that afferent loop syndrome should be considered in patients with previous gastric reconstruction who present with acute pancreatitis, even years after surgery. Early contrast-enhanced CT, together with prompt surgical intervention when indicated, is essential for identifying the underlying mechanical obstruction and improving patient outcomes.