Yeungnam Univ J Med.  2016 Dec;33(2):166-169. 10.12701/yujm.2016.33.2.166.

Deep vein thrombosis caused by malignant afferent loop obstruction

• Kang EG
• Kim C
• Lee J
• Cha MU
• Kim JH
• Park SH
• Kim MD
• Lee DY
• Rha SY

• KMID: 2366134
• DOI: http://doi.org/10.12701/yujm.2016.33.2.166

Abstract

Afferent loop obstruction following gastrectomy is a rare but fatal complication. Clinical features of afferent loop obstruction are mainly gastrointestinal symptoms. A 56-year-old female underwent radical total gastrectomy with Roux-en-Y esophagojejunostomy for treatment of advanced gastric cancer. After fourteen months postoperatively, she showed gradual development of edema of both legs. Computed tomography (CT) scan showed disease progression at the jejunojejunostomy site and consequent dilated afferent loop, which resulted in inferior vena cava (IVC) compression. A drainage catheter was placed percutaneously into the afferent loop through the intrahepatic duct and an IVC filter was placed at the suprarenal IVC, and selfexpanding metal stents were inserted into bilateral common iliac veins. With these procedures, sympotms related with afferent loop obstruction and deep vein thrombosis were improved dramatically. The follow-up abdominal CT scan was taken 3 weeks later and revealed the completely decompressed afferent loop and improved IVC patency. Surgical treatment should be considered as the first choice for afferent loop obstruction; however, because it is more immediate and less invasive, non-surgical modalities, such as percutaneous catheter drainage or stent placement, can be effective alternatives for inoperable cases or risky patients who have severe medical comorbidities.

Keyword

Afferent loop obstruction; Stomach cancer; Venous thrombosis; Interventional radiography

MeSH Terms

Catheters
Comorbidity
Disease Progression
Drainage
Edema
Female
Follow-Up Studies
Gastrectomy
Humans
Iliac Vein
Leg
Middle Aged
Radiography, Interventional
Stents
Stomach Neoplasms
Tomography, X-Ray Computed
Vena Cava, Inferior
Venous Thrombosis*