Percutaneous transhepatic metallic stent insertion for malignant afferent loop obstruction following pancreaticoduodenectomy: a case report

Journal of Medical Case Reports

Masaru Miyazaki¹  Katsunori Furukawa¹  Hiroaki Shimizu¹  Atsushi Kato¹  Isamu Hosokawa¹ 

[1] Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

关键词: Self-expanding metallic stent;    Percutaneous transhepatic biliary drainage;    Pancreaticoduodenectomy;    Malignant afferent loop obstruction;   

Others  :  1195658
DOI  :  10.1186/1752-1947-6-198

 received in 2012-03-07, accepted in 2012-05-15,  发布年份 2012

【 摘 要 】

Introduction

Malignant afferent loop obstruction following pancreaticoduodenectomy is a rare complication and may be fatal if suppurative cholangitis or obstructive jaundice develops. Effective and safe therapeutic strategies for malignant afferent loop obstruction following pancreaticoduodenectomy are scarce at present.

Case presentation

A 51-year-old Japanese man underwent pancreaticoduodenectomy for carcinoma of the papilla of Vater. Seven months postoperatively, he developed a high-grade fever, jaundice, and right upper abdominal pain. Abdominal contrast-enhanced computed tomography showed afferent loop obstruction and intrahepatic bile duct dilatation due to nodal recurrence. Percutaneous transhepatic biliary drainage was performed, and a self-expanding metallic stent (WallFlex™ duodenal stent) was placed across the stricture using the transhepatic route.

Conclusions

There are surgical and nonsurgical treatments for malignant afferent loop obstruction following pancreaticoduodenectomy. Nonsurgical treatments include either an endoscopic or percutaneous approach to the afferent loop. Of these methods, percutaneous transhepatic insertion of a self-expanding metallic stent is the preferred treatment for malignant afferent loop obstruction following pancreaticoduodenectomy because it is more prompt and less invasive.

【 授权许可】

   
2012 Hosokawa et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Chevalliera P, Novellasa S, Motamedia JP, Gugenheimb J, Brunner P, Bruneton JN: Percutaneous jejunostomy and stent placement for treatment of malignant Roux-en-Y obstruction: a case report. Clin Imaging 2006, 30:283-286.
• [2]Laasch HU: Obstructive jaundice after bilioenteric anastomosis: transhepatic and direct percutaneous enteral stent insertion for afferent loop occlusion. Gut Liver 2010, 4(Suppl 1):S89-S95.
• [3]Aimoto T, Uchida E, Nakamura Y, Katsuno A, Chou K, Tajiri T, Naito Z: Malignant afferent loop obstruction following pancreaticoduodenectomy: report of two cases. J Nippon Med Sch 2006, 73:226-230.
• [4]Burdick JS, Garza AA, Magee DJ, Dykes C, Jeyarajah R: Endoscopic management of afferent loop syndrome of malignant etiology. Gastrointest Endosc 2002, 55:602-605.
• [5]Caldicott DG, Ziprin P, Morgan R: Transhepatic insertion of a metallic stent for the relief of malignant afferent loop obstruction. Cardiovasc Intervent Radiol 2000, 23:138-151.
• [6]van Delden OM, Laméris JS: Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol 2008, 18:448-456.
• [7]Pannala R, Brandabur JJ, Gan SI, Gluck M, Irani S, Patterson DJ, Ross AS, Dorer R, Traverso LW, Picozzi VJ, Kozarek RA: Afferent limb syndrome and delayed GI problems after pancreaticoduodenectomy for pancreatic cancer: single-center, 14-year experience. Gastrointest Endosc 2011, 74:295-302.
• [8]Yao NS, Wu CW, Tiu CM, Liu JM, Whang-Peng J, Chen LT: Percutaneous transhepatic duodenal drainage as an alternative approach in afferent loop obstruction with secondary obstructive jaundice in recurrent gastric cancer. Cardiovasc Intervent Radiol 1998, 21:350-353.
• [9]Koornstra JJ, Alkefaji H: Self-expandable metal stent placement combining double balloon endoscopy with a percutaneous approach in a Roux-en-Y hepaticojejunostomy. J Gastrointestin Liver Dis 2009, 18:375-377.
• [10]Johnsson E, Delle M, Lundell L, Liedman B: Transhepatic placement of an enteral stent to treat jaundice in a tumor recurrence obstructed afferent loop after a whipple procedure. Dig Surg 2003, 20:329-331.