A Case of Afferent Loop Obstruction Early after Total Gastrectomy for Gastric Remnant Cancer with Roux-Y Reconstruction Cured by Percutaneous Transhepatic Cholangiodrainage

Junya Murase, Susumu Kaseno and Masasi Siomi

Department of Surgery, Nagayoshi General Hospital

Afferent loop obstruction is a dismal disease requiring prompt diagnosis and treatment. A 60-year-old man undergoing total gastrectomy for gastric remnant cancer with Roux-Y reconstruction (antcolic) had been operated on 25 years earlier for a gastric ulcer with wide resection and Billroth II reconstruction (retrocolic). Soon after surgery, bleeding from the elevated jejunum mesentery necessitated relaparotomy. On postoperative day (POD) 12, liver dysfunction and hyperamylasemia were observed and computed tomograph (CT) scan showed a markedly dilated duodenum and afferent loop obstruction. Because the intrahepatic bile duct was mildly dilated, percutaneous transhepatic cholangiodrainage (PTCD) on POD 15 was conducted under ultrasonic (US) guidance and dilation of the duodenum was improved using a PTCD catheter. The obstructive segment was around the Treitz ligament, and continuous drainage of the segment improved passage. On POD 35, the catheter was removed. PTCD appears to be one of a very effective procedures for treating afferent loop obstruction without surgery.

Key words
afferent loop obstruction, total gastrectomy, percutaneous transhepatic cholangiodrainage

Reprint requests
Junya Murase Department of Surgery, Nagayoshi General Hospital
1-2-34 Nagayoshinagahara, Hirano-ku, Osaka, 547-0016 JAPAN

Accepted
November 18, 2009

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