A Case of Duodenal Perforation Suspiciously due to Afferent Loop Obstruction which Improved by Percutaneous Drainage

Abstract

A 66-year-old man who underwent distal gastrectomy and Billroth-II reconstruction for gastric cancer 17 years earlier presented to our hospital with epigastralgia. There was tenderness in the epigastric area, but no peritoneal irritation symptoms were observed. Blood tests revealed elevated white blood cell counts, and a CT scan of the abdomen revealed abscess near the duodenal stump. The duodenum was mildly dilated, and fluid accumulation was observed around the duodenal stump, leading to the diagnosis of duodenal perforation due to suspected afferent loop obstruction. Because the findings were localized and the patient's general condition was stable, we decided to treat the patient conservatively. Percutaneous intraabdominal abscess drainage was performed on the 6th hospital day, and the patient was discharged on the 15th hospital day with the drain still in place. The drain was removed at our outpatient clinic, and thereafter no exacerbation of abdominal symptoms has occurred.

Duodenal perforation due to afferent loop obstruction is a serious disease with high mortality rate. We report a case of duodenal perforation suspiciously due to afferent loop obstruction after gastric cancer surgery that was successfully treated by percutaneous drainage.