title: Pancreaticoduodenectomy following total gastrectomy: a case report and literature review.
abstract: We present a case of afferent loop syndrome (ALS) occurring after pancreaticoduodenectomy (PD) in a patient who had previously undergone total gastrectomy (TG), and review the English-language literature concerning reconstruction procedures following PD in patients who had undergone TG. The patient was a 69-year-old man who had undergone TG reconstruction by a Roux-en-Y method at age 58 years. The patient underwent PD for pancreas head adenocarcinoma. A jejunal limb previously made at the prior TG was used for pancreaticojejunostomy and hepaticojejunostomy. Despite normal patency of the hepaticojejunostomy, he suffered from repeated postoperative cholangitis which was brought on by ALS due to shortness of the jejunal limb (15 cm in length). We therefore performed receliotomy in which the hepaticojejunostomy was disconnected and reconstructed using a new Y limb 40-cm in length constructed in a double Roux-en-Y fashion. The refractory cholangitis resolved immediately after the receliotomy and did not recur. Review of the literature revealed the lack of any current consensus for a standard procedure for reconstruction following PD in patients who had previously undergone TG. This issue warrants further attention, particularly given the expected future increase in the number of PDs in patients with a history of gastric cancer.
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yokoyama
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Sekioka
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Ueno
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Higashide
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Okishio
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Kawaguchi
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hagihara
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Yamada
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kamimura
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Kuwahara
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Ichimiya
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Utsunomiya
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Uyama
authors.affiliation: Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kato
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000343:Afferent Loop Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D002761:Cholangitis / Q000209:etiology; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012086:Reoperation; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Afferent loop syndrome after pancreaticoduodenectomy; Pancreaticoduodenectomy following total gastrectomy