title: Recurrent cholangitis by biliary stasis due to non-obstructive afferent loop syndrome after pylorus-preserving pancreatoduodenectomy: report of a case.
abstract: We report a 71-year-old man who had undergone pylorus-preserving pancreatoduodenectomy (PPPD) using PPPD-IV reconstruction for cholangiocarcinoma. For 6 years thereafter, he had suffered recurrent cholangitis, and also a right liver abscess (S5/8), which required percutaneous drainage at 9 years after PPPD. At 16 years after PPPD, he had been admitted to the other hospital because of acute purulent cholangitis. Although medical treatment resolved the cholangitis, the patient was referred to our hospital because of dilatation of the intrahepatic biliary duct (B2). Peroral double-balloon enteroscopy revealed that the diameter of the hepaticojejunostomy anastomosis was 12 mm, and cholangiography detected intrahepatic stones. Lithotripsy was performed using a basket catheter. At 1 year after lithotripsy procedure, the patient is doing well. Hepatobiliary scintigraphy at 60 minutes after intravenous injection demonstrated that deposit of the tracer still remained in the upper afferent loop jejunum. Therefore, we considered that the recurrent cholangitis, liver abscess, and intrahepatic lithiasis have been caused by biliary stasis due to nonobstructive afferent loop syndrome. Biliary retention due to nonobstructive afferent loop syndrome may cause recurrent cholangitis or liver abscess after hepaticojejunostomy, and double-balloon enteroscopy and hepatobiliary scintigraphy are useful for the diagnosis of nonobstructive afferent loop syndrome.
authors: 1 Department of Surgery, Jichi Medical University, Shimotsuke, Japan.
authors: Yukihiro
authors: Y
authors: Sanada
authors: Naoya
authors: N
authors: Yamada
authors: Masanobu
authors: M
authors: Taguchi
authors: Kazue
authors: K
authors: Morishima
authors: Naoya
authors: N
authors: Kasahara
authors: Yuji
authors: Y
authors: Kaneda
authors: Atsushi
authors: A
authors: Miki
authors: Yasunao
authors: Y
authors: Ishiguro
authors: Akira
authors: A
authors: Kurogochi
authors: Kazuhiro
authors: K
authors: Endo
authors: Masaru
authors: M
authors: Koizumi
authors: Hideki
authors: H
authors: Sasanuma
authors: Takehito
authors: T
authors: Fujiwara
authors: Yasunaru
authors: Y
authors: Sakuma
authors: Atsushi
authors: A
authors: Shimizu
authors: Masanobu
authors: M
authors: Hyodo
authors: Naohiro
authors: N
authors: Sata
authors: Yoshikazu
authors: Y
authors: Yasuda
mesh_terms: D000343:Afferent Loop Syndrome / Q000150:complications* / Q000175:diagnosis; D000368:Aged; D000714:Anastomosis, Surgical; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D002758:Cholangiography; D002761:Cholangitis / Q000175:diagnosis / Q000209:etiology*; D003251:Constriction, Pathologic; D003937:Diagnosis, Differential; D006801:Humans; D020347:Lithiasis / Q000175:diagnosis / Q000628:therapy; D008096:Lithotripsy; D008107:Liver Diseases / Q000175:diagnosis / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D016577:Pancreaticoduodenectomy; D012008:Recurrence; D014057:Tomography, X-Ray Computed
keywords: Biliary stasis; Double-balloon enteroscopy; Hepaticojejunostomy; Hepatobiliary scintigraphy; Nonobstructive afferent loop syndrome