Clin Endosc.  2013 Nov;46(6):679-682.

Percutaneous Cholangioscopic Lithotripsy for Afferent Loop Syndrome Caused by Enterolith Development after Roux-en-Y Hepaticojejunostomy: A Case Report

• Kim SH
• Jeong S
• Lee DH
• Yoo SS
• Lee KY

Abstract

Afferent loop obstruction caused by enterolith formation is rare and cannot be easily treated with endoscopy because of the difficulty associated with the nonsurgical removal of enteroliths. A 74-year-old woman was admitted with fever and acute abdominal pain. Clinical features and imaging studies suggested afferent loop obstruction caused by an enterolith after Roux-en-Y hepaticojejunostomy. Percutaneous transhepatic biliary drainage was initially performed because of severe cholangitis with septic shock. The enterolith was located in the jejunal limb adjacent to the hepaticojejunostomy site. Cholangioscopic lithotripsy was performed through the percutaneous transhepatic route to the enterolith, and the fragments were moved into the efferent loop using scope push and saline flush methods. Here, we describe a case of afferent loop syndrome caused by an enterolith that developed after Roux-en-Y hepaticojejunostomy and was treated with percutaneous transhepatic cholangio-enteroscopic lithotripsy.

Keyword

Afferent loop syndrome; Anastomosis, Roux-en-Y; Lithotripsy

MeSH Terms

Abdominal Pain
Afferent Loop Syndrome*
Aged
Anastomosis, Roux-en-Y
Cholangitis
Drainage
Endoscopy
Extremities
Female
Fever
Humans
Lithotripsy*
Methods
Shock, Septic

Figure

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  Fig. 1 Abdominal computed tomography shows an enterolith (white arrow) measuring 3 cm in the proximal afferent loop.

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  Fig. 2 (A) Cholangioscopy shows a black-pigmented intrahepatic duct stone and (B) an enterolith in the proximal jejunum.

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  Fig. 3 (A) Cholangioenterogram shows an enterolith (white arrows) obstructing the afferent loop. (B) Cholangioenterogram shows a broken enterolith (white arrows), which was swept to the jejunojejunal anastomosis site.

Reference

1. Lee MC, Bui JT, Knuttinen MG, Gaba RC, Scott Helton W, Owens CA. Enterolith causing afferent loop obstruction: a case report and literature review. Cardiovasc Intervent Radiol. 2009; 32:1091–1096. PMID: 19365684.

2. Tan WS, Chung AY, Low AS, Cheah FK, Ong SC. Enterolith formation in the roux limb hepaticojejunostomy. Dig Dis Sci. 2007; 52:3214–3216. PMID: 17909975.

3. Tien YW, Lee PH, Chang KJ. Enterolith: an unusual cause of afferent loop obstruction. Am J Gastroenterol. 1999; 94:1391–1392. PMID: 10235224.

4. Carbognin G, Biasiutti C, El-Khaldi M, Ceratti S, Procacci C. Afferent loop syndrome presenting as enterolith after Billroth II subtotal gastrectomy: a case report. Abdom Imaging. 2000; 25:129–131. PMID: 10675451.

5. Wada N, Seki M, Saikawa Y, et al. Jejunal limb obstruction caused by a cholesterol stone 15 years after a total gastrectomy and 20 years after a cholecystectomy: report of a case. Surg Today. 2000; 30:181–184. PMID: 10664345.

6. Capaccio E, Zuccarino F, Gauglio C, Pretolesi F, Derchi LE. Acute obstruction of the afferent loop caused by an enterolith. Emerg Radiol. 2007; 13:201–203. PMID: 17109128.

7. Kim HJ, Moon JH, Choi HJ, et al. Endoscopic removal of an enterolith causing afferent loop syndrome using electrohydraulic lithotripsy. Dig Endosc. 2010; 22:220–222. PMID: 20642613.