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Introduction:Patients suffering from chronic pancreatic pain may undergo a Whipple procedure to help relieve their pain. However, after months or years of relief, some develop symptoms of nausea, vomiting and recurrent abdominal pain. We present a retrospective review of patients who had a Whipple for chronic pancreatic pain who developed clinical symptoms suspicious for afferent loop syndrome and their outcomes after a Braun entero-enterostomy. Methods:We reviewed our patient database over the last 5 years and identified patients who underwent a Whipple for chronic pancreatic pain. 16 patients were identified and 7 had suspected afferent loop syndrome based on their clinical symptoms, labs, and multiple imaging modalities including 2-hour quantitative HIDA scans. 5 underwent a Braun entero-enterostomy 3 to 7 years out from their Whipple procedure (4 had a pylorus sparing Whipple and one a Whipple with a distal gastrectomy and Billroth II anastomosis). 4 of the Braun entero-enterostomies were done with laparoscopy. The fifth had an open Puestow type revision of the pancreatico-jejunostomy along with a Braun entero-enterostomy. 4 reported an improvement- 3 with a Braun entero-enterostomy and one with a Braun combined with a Puestow. One patient did not have any improvement. This patient had a standard Whipple with gastrectomy and Billroth II.Results:The table represents the subjective classification of the intensity of the patient’s symptoms before and after Braun entero-enterostomy. With the exception of patient E, all patients described some measure of improvement in their symptoms. Conclusions:The development of nausea, vomiting and abdominal pain after a latency period in patients with pylorus sparing Whipple for chronic pain syndrome may be due to poor drainage of the afferent loop which may be relieved by diversion through a Braun entero-enterostomy.
Symptom comparison pre and post Braun entero-enterostomy

patient /symptom	Belching/ Bloating		Nausea		Vomiting		RUQ pain		LUQ pain		Epigastric Pain		Overall
A	-	-	9	4	4	0	5	0	-	-	-	-	8	0
B	10	2	10	5	-	-	3	3	-	-	-	-	10	6
C	4	0	9	5	4	0	10	8	10	7	10	5	10	7
D with Puestow	6	4	6	4	5	3	6	4	5	4	6	4	6	4
E	8	8	8	8	8	8	8	8	7	7	8	8	no change

Patients reported a subjective numerical value to their symptoms with 10 being severe and 0 resolved