Aimoto Takayuki, Uchida Eiji, Nakamura Yoshiharu, Katsuno Akira, Chou Kazumitsu, Tajiri Takashi, Naito Zenya
Surgery for Organ Function and Biological Regulation, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
J Nippon Med Sch. 2006 Aug;73(4):226-30. doi: 10.1272/jnms.73.226.
We report two cases of malignant afferent loop obstruction following pancreaticoduodenectomy (PD). Case 1. A 70-year-old woman, who had undergone PD for pancreatic cancer, was referred to our hospital because of fever, jaundice, and abdominal pain. Ultrasonography and abdominal computed tomography demonstrated dilatation of a small bowel loop in the right upper quadrant. Laparotomy confirmed the diagnosis of local recurrent tumor causing occlusion of the afferent limb, and Roux-en-Y bypass was performed. Case 2. A 72-year-old man, who had undergone PD for cancer of the major papilla, was hospitalized with a high-grade fever and epigastric pain. Ultrasonography and abdominal computed tomography revealed a dilated afferent loop and multiple masses in liver. At laparotomy, widespread carcinomatosis was found to have caused afferent loop obstruction, and surgical bypass was performed. In conclusion, the surgical bypass seems to be an effective palliative treatment for afferent loop syndrome after PD.
我们报告了两例胰十二指肠切除术（PD）后发生的恶性输入袢梗阻病例。病例1：一名70岁女性，因胰腺癌接受了PD手术，因发热、黄疸和腹痛被转诊至我院。超声检查和腹部计算机断层扫描显示右上腹小肠袢扩张。剖腹手术证实诊断为局部复发性肿瘤导致输入袢闭塞，并进行了Roux-en-Y旁路手术。病例2：一名72岁男性，因主乳头癌接受了PD手术，因高热和上腹部疼痛入院。超声检查和腹部计算机断层扫描显示输入袢扩张和肝脏多发肿块。剖腹手术时发现广泛的癌转移导致输入袢梗阻，并进行了手术旁路手术。总之，手术旁路似乎是PD后输入袢综合征的一种有效的姑息治疗方法。
