S1809 Portal Cavernoma Cholangiopathy Presenting With Acute Cholangitis

Abstract

Discussion: ALS is a rare complication of gastrojejunostomy due to distal obstruction of the afferent limb leading to accumulation of digestive secretions here while the alimentary limb remains patent. Etiology includes adhesions, stenosis from marginal ulceration, cancer recurrence, and enteroliths. CT finding of dilated afferent limb is diagnostic. Management involves consideration of etiology, site, and functional status. In malignant ALS, management targets primarily palliative treatment and secondarily surgery with curative intent. Key points from the case are: While ALS most commonly follows Billroth II, it can occur in RYGB; Decompression via G-tube placed at the dilated limb proximal to obstruction serves as a palliative measure prior to definitive surgery; While most malignant ALS cases involve recurrence, this mass was uncovered via ALS; While conventional management of malignant ALS was surgical, percutaneous and endoscopic methods are increasingly being employed.[1807] Figure 1. Upper GI series with contrast injected via the catheter of the percutaneous gastrostomy tube demonstrates persistent contrast in the excluded portion of the reconstruction including the gastric remnant and proximal duodenum at 5 hours and 40 minutes.