Korean J Hepatobiliary Pancreat Surg.  2015 May;19(2):66-70. 10.14701/kjhbps.2015.19.2.66.

Balloon dilation of jejunal afferent loop functional stenosis following left hepatectomy and hepaticojejunostomy long time after pylorus-preserving pancreaticoduodenectomy: a case report

Affiliations
  • 1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr
  • 2Department of Diagnostic Imaging, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

We present a rare case of functional stenosis of the jejunal loop following left hepatectomy and hepaticojejunostomy long after pylorus-preserving pancreaticoduodenectomy (PPPD), which was successfully managed by balloon dilation. A 70-year-old Korean man had undergone PPPD 6 years before due to 1.8 cm-sized distal bile duct cancer. Sudden onset of obstructive jaundice led to diagnosis of recurrent bile duct cancer mimicking perihilar cholangiocarcinoma of type IIIb. After left portal vein embolization, the patient underwent resection of the left liver and caudate lobe and remnant extrahepatic bile duct. The pre-existing jejunal loop and choledochojejunostomy site were used again for new hepaticojejunostomy. The patient recovered uneventfully, but clamping of the percutaneous transhepatic biliary drainage (PTBD) tube resulted in cholangitis. Biliary imaging studies revealed that biliary passage into the afferent jejunal limb was significantly impaired. We performed balloon dilation of the afferent jejunal loop by using a 20 mm-wide balloon. Follow-up hepatobiliary scintigraphy showed gradual improvement in biliary excretion and the PTBD tube was removed at 1 month after balloon dilation. This very unusual condition was regarded as disuse atrophy of the jejunal loop, which was successfully managed by balloon dilation and intraluminal keeping of a large-bore PTBD tube for 1 month.

Keyword

Balloon dilation; Functional stenosis; Disuse atrophy; Hepaticojejunostomy; Redo surgery

MeSH Terms

Aged
Bile Duct Neoplasms
Bile Ducts, Extrahepatic
Cholangiocarcinoma
Cholangitis
Choledochostomy
Constriction
Constriction, Pathologic*
Diagnosis
Drainage
Extremities
Follow-Up Studies
Hepatectomy*
Humans
Jaundice, Obstructive
Liver
Muscular Disorders, Atrophic
Pancreaticoduodenectomy*
Portal Vein
Radionuclide Imaging
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