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

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. inos@inha.ac.kr
  • 2Center for Advanced Medical Education by Brain Korea 21 Project, Inha University School of Medicine, Incheon, Korea.
  • 3Utah-Inha DDS & Advanced Therapeutics Research Center, Incheon, Korea.
  • 4Department of Surgery, Inha University School of Medicine, Incheon, Korea.

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
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