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An elderly patient presented to our institution with abdominal pain, nausea and vomiting. She had an extensive surgical background including gastrectomy with Roux-en-y reconstruction undertaken 15 years earlier.A CT abdomen demonstrated a small bowel obstruction proximal to the jejunojejunostomy with features suggestive of afferent loop syndrome (ALS), a rare but known complication following Roux-en-y reconstruction. Initial surgery identifid a band adhesion and an associated ischemic small bowel segment, which was resected with primary anastomosis. A further operation was required at post-operative day fie due to clinical deterioration. A retroperitoneal collection was identifid secondary to perforation of the afferent loop.
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