A Case of Afferent Loop Syndrome After Gastrectomy with Billroth-type Ⅱ Reconstruction Successfully Treated by Percutaneous Transhepatic Gallbladder Drainage and Elective Operation

Abstract

Afferent loop syndrome associated with remnant gastric cancer is extremely rare. A 72-year-old man who had undergone distal gastrectomy for a gastric ulcer 40 years earlier was admitted to the hospital complaining of nausea. Laboratory studies revealed hyperamylasemia, and abdominal CT showed a fluid-filled dilated afferent loop and mass lesion near the gastrojejunostomy. Emergency upper gastrointestinal endoscopic examination revealed a lesion suggestive of type 4 gastric cancer at the gastrojejunostomy. The afferent limb was obstructed due to the cancer, so that we could not insert a drainage tube into it. We diagnosed afferent loop syndrome associated with remnant gastric cancer, and performed percutaneous transhepatic gallbladder drainage(PTGBD); one week later, the drainage catheter was passed transpapillarily into the duodenum. The dilatation of the afferent loop improved, so that the patient was scheduled for an elective surgery for the remnant gastric cancer. PTGBD followed by elective surgery is one of the effective ways of treating afferent loop syndrome associated with remnant gastric cancer.