title: Percutaneous transhepatic insertion of metal stents with a double-pigtail catheter in afferent loop obstruction following distal gastrectomy.
abstract: 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.
authors.affiliation: First Department of Surgery, Nippon Medical School, Tokyo, Japan. hiroshiy@nms.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kawano
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mizuguchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Shimizu
authors.forename: Tsubasa
authors.initials: T
authors.lastname: Takahashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okuda
authors.forename: Masao
authors.initials: M
authors.lastname: Miyashita
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
mesh_terms: D000343:Afferent Loop Syndrome / Q000175:diagnosis / Q000628:therapy*; D000368:Aged; D002408:Catheters, Indwelling; D004867:Equipment Design; D005743:Gastrectomy; D005763:Gastroenterostomy; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D015607:Stents; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed