J Korean Soc Radiol.  2019 Mar;80(2):333-338. 10.3348/jksr.2019.80.2.333.

Percutaneous Transabdominal Metallic Stent Placement for Palliation of Afferent Loop Syndrome: A Case Report

Affiliations
  • 1Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea. ymhan@jbnu.ac.kr
  • 2Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
  • 3Biomedical Research Institute, Chonbuk National University Medical School and Hospital, Jeonju, Korea.

Abstract

The authors report a successful outcome after percutaneous transabdominal placement of a self-expandable metallic stent in a patient who had afferent loop syndrome caused by recurrent common bile duct adenocarcinoma. Enhanced abdominal CT showed marked dilation of the afferent loop adjacent to the anterior peritoneum, multiple hepatic metastases and lymph node metastasis around the choledochojejunal anastomosis site without marked dilation of intrahepatic bile ducts. Percutaneous drainage catheter was successfully placed to the dilated afferent loop just below the abdominal wall. Subsequent successful palliation of the afferent loop obstruction was achieved by placing a self-expandable metallic stent via the transabdominal route with the aid of cone-beam CT.


MeSH Terms

Abdominal Wall
Adenocarcinoma
Afferent Loop Syndrome*
Bile Ducts, Intrahepatic
Catheters
Common Bile Duct
Common Bile Duct Neoplasms
Cone-Beam Computed Tomography
Drainage
Humans
Lymph Nodes
Neoplasm Metastasis
Peritoneum
Self Expandable Metallic Stents
Stents*
Tomography, X-Ray Computed

Figure

  • Fig. 1 A 72-year-old man diagnosed with afferent loop syndrome, treated with percutaneous transabdominal metallic stent placement for palliation. A. Abdominal contrast-enhanced CT on admission shows a markedly dilated afferent loop adjacent to the anterior peritoneum. B. The afferent loop is kinked at the choledochojejunostomy site (asterisk). Multiple masses with low enhancement suggesting hepatic metastasis of adenocarcinoma, and lymph node metastases around the choledochojejunal anastomosis site are shown without marked dilation of both intrahepatic bile ducts. C. An 8.5-Fr pigtail catheter is inserted into the afferent loop via the percutaneous transabdominal route. The biliary tree is dilated due to the infused contrast media. D. Cone-beam CT shows the outflow tract at the posterior aspect of the afferent limb (asterisk). E. Jejunography confirms an approximately 4-cm-long stricture of the afferent loop (arrows). F. A 20-mm and 8-cm self-expanding metallic stent was placed across the stenosis via the transabdominal route. A 12-Fr pigtail catheter is placed at the end of stent placement.


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