2023 Volume 65 Issue 6 Pages 1128-1135
A 71-year-old woman was admitted to our hospital with epigastric pain. Computed tomography revealed a 55mm-sized tumor in the body of the pancreas resulting in distal biliary obstruction. She was diagnosed with unresectable pancreatic cancer. Although we inserted a covered self-expandable metal stent (SEMS), she developed multiple liver abscesses due to non-occlusion cholangitis the following day. We performed percutaneous transhepatic liver abscess drainage, endoscopic naso-biliary drainage, and removal of the SEMS; however, her condition did not improve. Therefore, we inserted a SEMS with a duckbill-shaped anti-reflux valve (D-ARMS). First, the D-ARMS migrated above the papilla after a period of three months, which resulted in exacerbation of the liver abscesses. After replacing the D-ARMS and increasing the length from the papilla to the lower end of the D-ARMS to prevent migration, the liver abscesses resolved without recurrence. D-ARMS may be an effective treatment for resolving uncontrollable non-occlusion cholangitis.
