Yoshida Hiroshi, Mamada Yasuhiro, Taniai Nobuhiko, Kawano Youichi, Mizuguchi Yoshiaki, Shimizu Tetsuya, Takahashi Tsubasa, Okuda Takeshi, Miyashita Masao, Tajiri Takashi
First Department of Surgery, Nippon Medical School, Tokyo, Japan.
Hepatogastroenterology. 2005 May-Jun;52(63):680-2.
We report successful outcome following transhepatic insertion of metal stents with a double-pigtail catheter in a patient with afferent loop syndrome caused by recurrent gastric carcinoma. A 77-year-old man was admitted with a 2-week history of fever, right upper quadrant pain, and jaundice. His past medical history included distal gastrectomy for treatment of gastric cancer two years previously. Abdominal computed tomography revealed marked dilation of the jejunal limb and intrahepatic bile duct. We diagnosed the patient with afferent loop syndrome resulting from recurrent cancer. Percutaneous transhepatic biliary drainage was performed, and a catheter was placed beyond the papilla of Vater. Approximately 1300 mL of turbid jejunal contents were removed. Symptoms resolved by one day after initiation of drainage. After 1 week, a sheath introducer was inserted beyond the point of stenosis, and two metal stents were placed. A double-pigtail catheter was inserted into the metal stents to prevent migration. Good stent placement was confirmed and the drainage catheter was removed.
