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
McCutcheon AD. Acute Pancreatitis Complicating Polya Gastrectomy. Arch Surg. 1997;132(4):452. doi:10.1001/archsurg.1997.01430280126026