• Ra Ri Cha, Su Beom Cho, Wan Soo Kim, Jin Joo Kim, Jae Min Lee, Sang Soo Lee, Hyun Jin Kim, and Jin Kyu Cho.
• Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon.
• Medicine (Baltimore). 2018 Dec 1; 97 (50): e13072.

RationaleSelf-expanding metal stent placement is a useful procedure for intestinal obstruction. Afferent loop syndrome after gastrectomy is an uncommon complication of gastroenterostomy reconstruction. Ascending cholangitis caused by afferent loop syndrome is a potential, but rare, complication.Patient ConcernsA 73-year-old man with abdominal pain and vomiting was admitted to the emergency room. His medical history was significant for subtotal gastrectomy with Billroth II anastomosis for benign gastric ulcer perforation 40 years prior. He had notable tenderness to palpation, particularly on the epigastric area, and a temperature of 39.0°C.DiagnosisAbdominal computed tomography revealed afferent loop syndrome with ascending cholangitis caused by remnant gastric cancer.InterventionsPercutaneous catheter drainage for management of ascending cholangitis was performed on the day of admission. He was subsequently treated with self-expandable metal stent insertion into the stenotic lesion.OutcomesAfter treatment with percutaneous transhepatic insertion of a self-expanding stent, the patient achieved complete resolution of symptoms. The patient died of disease progression 2 months later, without further recurrence of afferent loop syndrome.LessonsOur case shows that insertion of a metal stent via percutaneous transhepatic biliary drainage (PTBD) can effectively treat ascending cholangitis and resolve afferent loop syndrome in inoperable patients.

22 keywords...

hide…