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A. Douglas McCutcheon, MD, FRACP
East Kew, Victoria, Australia

Arch Surg. 1997;132(4):452.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

I read with interest the article titled "Recurrent Acute Pancreatitis Caused by Afferent Loop Stricture After Gastrectomy" by Mithöfer and Warshaw¹ and would like to make the following comment. Contrary to what is stated by these authors, the mechanism by which afferent loop obstruction causes acute pancreatitis after a Polya gastrectomy is well established.

A closed duodenal loop in dogs and rats produces severe acute pancreatitis that closely resembles clinical pancreatitis, and it results from the reflux of duodenal contents into the pancreatic duct.^2,3 Wallensten⁴ recorded 12 deaths from pancreatitis after a Polya gastrectomy and attributed this to the occasional transformation of the afferent loop into a blind sac. Four similar, but nonfatal, cases were reported by Perman.⁵ The anatomical abnormality is basically the same as in the canine experiments, and little doubt exists that reflux of duodenal contents is responsible for causing acute pancreatitis in . . . [Full Text PDF of this Article]

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