Korean J Med.  2015 Oct;89(4):428-432. 10.3904/kjm.2015.89.4.428.

A Case of Afferent Loop Syndrome Treated by Endoscopic Metal Stent Insertion Using Two Endoscopes

• Kim JJ
• Cheon YK
• Lee TY
• Shim CS

• KMID: 2268975
• DOI: http://doi.org/10.3904/kjm.2015.89.4.428

Abstract

Afferent loop syndrome is a rare complication of pancreaticoduodenectomy, and the endoscopic approach is difficult due to the surgically altered anatomy. Herein, we report a case of afferent loop obstruction treated by endoscopic metal stent insertion using two endoscopes. A 57-year-old male who had undergone the Whipple operation 7 months prior for pancreatic head cancer presented with abdominal pain and jaundice. Abdominal computed tomography showed afferent loop obstruction due to recurrent metastatic pancreatic cancer. First, we attempted to insert the stent using percutaneous transhepatic approaches following percutaneous transhepatic biliary drainage, but these failed. We therefore accessed the obstruction site using a relatively thin endoscope and then exchanged this endoscope for another with a large working channel, through which the self-expandable metal stent was passed. The stent was inserted successfully. This method will increase the success rate of endoscopic treatment.

Keyword

Afferent loop syndrome; Pancreaticoduodenectomy; Pancreatic neoplasm; Endoscopy

MeSH Terms

Abdominal Pain
Afferent Loop Syndrome*
Drainage
Endoscopes*
Endoscopy
Head and Neck Neoplasms
Humans
Jaundice
Male
Middle Aged
Pancreatic Neoplasms
Pancreaticoduodenectomy
Stents*