Korean J Gastroenterol.  2016 Dec;68(6):326-330. 10.4166/kjg.2016.68.6.326.

Duodenal Loop Obstruction as an Unusual Cause of Acute Pancreatitis: A Case Series

• Lee H
• Choi Y
• Jeong H
• Lim JK
• Jung T
• Han JH
• Park SM

• KMID: 2383464
• DOI: http://doi.org/10.4166/kjg.2016.68.6.326

Abstract

Duodenal loop obstruction is an unusual cause of acute pancreatitis. Increased intraluminal pressure hinders pancreatic flow, causing dilatation of the pancreatic duct and inducing acute pancreatitis. We experienced three cases of acute pancreatitis that resulted from duodenal loop obstruction after (1) an esophagectomy with gastric pull-up procedure for esophageal cancer, (2) a gastrectomy with Billroth I reconstruction for gastric cancer, and (3) a gastrojejunostomy for abdominal trauma. An abdominal CT scan revealed a distended duodenal loop, dilated pancreatic duct, and inflamed pancreas with fluid collection. Acute pancreatitis with duodenal loop obstruction was diagnosed by abdominal pain, elevated serum amylase/lipase, and abdominal CT findings. Immediate decompression with a nasogastric tube was performed, and all patients showed improvement within one week after admission. Each patient was followed up for more than two years without recurrence. Our findings suggest the usefulness of nasogastric tube decompression as the first line of treatment for acute pancreatitis related to duodenal loop obstruction.

Keyword

Pancreatitis, acute; Duodenal obstruction; Decompression

MeSH Terms

Abdominal Pain
Decompression
Dilatation
Duodenal Obstruction
Esophageal Neoplasms
Esophagectomy
Gastrectomy
Gastric Bypass
Gastroenterostomy
Humans
Pancreas
Pancreatic Ducts
Pancreatitis*
Recurrence
Stomach Neoplasms
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Plain abdomen and abdominal CT images of Case 1. (A) Suspicious distended stomach filled with fluid (asterisk) without abnormal bowel gas. (B) Axial view. Dilatation of the duodenum (asterisk) and diffuse small bowel wall thickening (arrow). (C) Coronal view. Distended duodenal loop (arrow) and mild pancreatic duct dilation (arrowhead).

• 

  Fig. 2. Plain abdomen and abdominal CT images of Case 2. (A) Suspicious distended stomach filled with fluid (asterisk) without abnormal bowel gas. (B) Axial view. A massive duodenal dilatation with a large volume of food inside (arrow). (C) Coronal view. Dilatation of the stomach (asterisk) and duodenal loop with abrupt luminal narrowing of the proximal jejunum (arrowhead). Swelling of the pancreas with peripancreatic fluid collection (arrow) is suggestive of acute pancreatitis.

• 

  Fig. 3. Plain abdomen and abdominal CT images of Case 3. (A) Linear air at right upper quadrant area (arrow), suspicious fluid-filled stomach (asterisks), and gaseous distended colonic loop and small bowels at right sided abdomen (arrowheads). (B, C) Axial views. Marked dilation of the stomach and duodenum (asterisks) and dilation of the pancreatic duct (arrow) with fluid collection (arrowhead). (D) Coronal view. A distended duodenal loop with abrupt luminal narrowing of the proximal jejunum (arrow) and fluid collection at the pancreatic tail (arrowhead). Plain abdominal film was revealed.

Reference

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