A Case of Afferent Loop Obstruction treated with Percutaneous Bowel Drainage Successfully

Hideyuki Ubukata, Teruhiko Kasuga, Gyou Motohashi, Motonobu Katano, Yoshinori Watanabe, Yoshihisa Gotoh, Ichiroh Nakada, Shigenori Satoh and Takafumi Tabuchi

4^th Department of Surgery, Tokyo Medical University

The case of an afferent loop obstruction is reported. A 65-year-old male received a total gastrectomy with Roux-Y reconstruction (retrocolic) because of gastric remnant cancer. He had been previously operated on for a gastric ulcer 40 years earlier with a wide resection and BillrothII reconstruction (retrocolic). On the third post-operative day (POD) after the gastrectomy, liver dysfunction was observed; on the fourth POD, the patient's upper abdominal pain began to worsen. On the ninth POD, a CT scan revealed a markedly dilated duodenum, and jaundice on his skin became noticeable on the twelfth POD. On thirteenth POD, a percutaneous bowel drainage (PBD) procedure was performed under US guidance, and an afferent loop obstruction was diagnosed. A UGI series showed a narrow segment about 10 cm distal to the gastrojejunal anastomosis. The patient's abdominal pain improved remarkably compared to the previous day, and the PBD catheter was removed and oral intake was resumed on the twenty-seventh POD. The patient's condition continued to improve, and he was discharged from hospital on the thirty-eight POD. Afferent loop obstruction is a very severe disease, and prompt recognition and immediate treatment are necessary. Most cases are treated using surgery, but the mortality rate is quite high (11%∼28%). Percutaneous bowel drainage might be a very effective and easy procedure for the treatment of afferent loop obstruction like the present case.

Key words
Afferent loop obstruction, Obstructive jaundice, Percutaneous bowel drainage

Reprint requests
Hideyuki Ubukata 4^th Department of Surgery, Tokyo Medical University, Kasumigaura Hospital 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395 JAPAN

Accepted
May 27, 2003

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