Bilious Vomiting After Gastric Surgery

A SMALL proportion of patients undergoing gastric surgery are incapacitated by postoperative digestive symptoms. If these are predominantly vasomotor in character, with varying combinations of palpitation, sweating, faintness, and explosive diarrhea, they have been broadly grouped as the "dumping syndrome." These may occur after any type of gastric surgery, but most commonly follow gastric resection. The frequency and severity of these symptoms have both been greatly decreased by the use of a more limited resection, made possible by the addition of vagotomy. The relatively rare symptom of vomiting of bile, often with persistent epigastric pain, has been called the "afferent loop syndrome," and has been well described by a number of authors.1-5The generally accepted explanation is stasis of bile and pancreatic secretions in the afferent loop of a gastrojejunostomy with sudden outflow into the stomach causing nausea and vomiting. This may occur at any time, but frequently occurs