Successful Decompression of an Afferent Loop Obstruction due to Peritoneal Dissemination after Gastrectomy with Percutaneous Transhepatic Biliary Drainage

Abstract

Although afferent loop syndrome associated with gastric cancer often requires surgical treatment, it remains unclear whether invasive procedures are appropriate for terminal cancer patients. Case : A 57-year-old man had undergone Roux-en Y reconstruction for distal gastrectomy. Multiple peritoneal dissemination nodules were observed and the histopathological diagnosis was poorly differentiated Stage Ⅳ adenocarcinoma. During postoperative chemotherapy, the patient developed a complicated malignant bowel obstruction. A segmental resection of small intestine with a concomitant colostomy did not improve the symptoms ; therefore, the treatment goal was shifted to palliative care for better quality of life. However, stiffness and pain in the lower back with high fever occurred subsequently. As a blood test and abdominal computed tomography (CT) indicated afferent loop syndrome, we performed a percutaneous transhepatic biliary drainage. A catheter tip was also successfully inserted into the duodenum to reduce the pressure of the afferent loop. Subsequently, the back pain improved. The patient was discharged from hospital and began to receive home care services. Conclusion : Our experience suggests that decompression of afferent loop syndrome through percutaneous transhepatic biliary drainage is a promising option for the treatment of afferent loop obstruction due to peritoneal dissemination, even in terminal patients. Key words：afferent loop obstruction，percutaneous transhepatic biliary drainage，peritoneal dissemination