Ileal loop interposition: an alternative biliary bypass technique.
BACKGROUND
Obstructive jaundice is a common condition in advanced digestive cancer. Palliative procedures can improve quality of life and allow patients to attempt a systemic treatment. Bilioenteric anastomosis is still the procedure of choice for patients in many centers. When a surgical bypass is not possible, biliary drainage can be done by placing endoscopic or transparietal stents, which are less durable methods even when an expandable stent is employed.


METHODS
A 47-year-old male with an excellent clinical status and a previous cholecystectomy and an exploratory laparotomy for advanced gastric cancer was referred with obstructive jaundice. A preoperative CT scan showed a dilated bile duct and a small mass at the distal hepatic hilum. No other signs of metastasis were found. A surgical bilioenteric anastomosis was indicated. At surgery, a distal choledochal obstruction and a mesenteric retraction by a lymph node mass prevented the jejunum to ascend for a bilioenteric anastomosis. Surgically, an alternative bilioenteric bypass was performed by means of an ileal loop interposition between the bile duct and the jejunum.


RESULTS
The recovery of the patient was uneventful and his bilirubin levels normalized after one week. The patient was then referred for systemic chemotherapy.


CONCLUSIONS
This alternative biliary bypass can be safely and easily performed, and may be a good alternative for patients already referred for surgery because of a better life expectancy and when the jejunum is not an alternative.
Abdominal Surgery Department, Hospital do Cancer AC Camargo, Rua Professor Antonio Prudente 211, Liberdade, Sao Paulo, Brazil. coimbra.felipe@uol.com.br
Felipe J F
FJ
Coimbra
Alessandro L
AL
Diniz
Heber Sc
HS
Ribeiro
Wilson L
WL
Costa
Eduardo N P
EN
Lima
Andre L
AL
Montagnini
D000714:Anastomosis, Surgical / Q000379:methods; D001652:Bile Ducts / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000601:surgery*; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000150:complications*