Abstract
A 72-year-old man underwent total gastrectomy for gastric cancer with a Roux-en-Y reconstruction. While the patient was stable soon after the surgery, on postoperative day 14, he developed left upper abdominal pain and a high-grade fever. Laboratory findings suggested liver dysfunction associated with cholangitis and an abdominal CT showed a markedly dilated duodenum with mild dilatation of the bile duct. Thus, a diagnosis of afferent loop obstruction associated with cholangitis was made. Percutaneous transhepatic cholangiodrainage (PTCD) was performed under US guidance, and the duodenal dilataion improved. Cholangiography using the catheter confirmed stenosis of the jejuno-jejunostomy causing the afferent loop obstruction. Continuous drainage of the duodenum using the PTCD catheter was effective for the management of the afferent loop obstruction. On day 66 after the start of the PTCD, the catheter was removed. Thus, PTCD appeared to be a very effective procedure for treating the afferent loop obstruction without surgery.
