Successful treatment of remnant gastric cancer with afferent loop syndrome managed by percutaneous transhepatic cholangial drainage followed by elective gastrectomy: a case report

Background There are only few reported cases of remnant gastric cancer with concomitant afferent loop syndrome. Emergency surgery is the standard treatment strategy for this disease. However, some afferent loop syndrome cases, especially those with complete obstruction, can lead to a septic state, which makes performing emergency surgery risky. We describe a case of remnant gastric cancer with complete afferent loop obstruction, which was successfully managed by radical surgery following percutaneous transhepatic cholangial drainage of the afferent loop. Case presentation A 71-year-old man presented with nausea and abdominal discomfort. When he was 27 years old, he had undergone distal gastrectomy for a benign gastric ulcer, with gastrojejunostomy (Billroth II reconstruction). Abdominal computed tomography revealed thickening of the anastomosis site and significant dilation of the afferent loop. Gastrointestinal fiberscopy revealed advanced remnant gastric cancer at the anastomosis site, and the stoma of the afferent loop was completely obstructed. We diagnosed the patient with remnant gastric cancer with afferent loop syndrome. Percutaneous transhepatic cholangial drainage was performed twice before surgery to decompress the afferent loop. This provided more time for the patient to recover. Radical surgery of total remnant gastrectomy and Roux-en-Y reconstruction were performed electively. There were no severe postoperative complications. The patient died 8 months following the operation owing to peritoneal dissemination recurrence. Conclusion We encountered a case of remnant gastric cancer with afferent loop obstruction, which was successfully managed by radical surgery following decompression of the afferent loop by percutaneous transhepatic cholangial drainage. Percutaneous transhepatic cholangial drainage effectively managed the afferent loop syndrome, resulting in the safe performance of elective surgery.

Fluoroscopy guided stent placement for the treatment of malignant afferent loop obstruction

BACKGROUND & AIM: To evaluate the efficacy and safety of fluoroscopy guided stent placement for the treatment of malignant afferent loop obstruction (ALO). METHODS 12 patients with malignant ALO in whom fluoroscopy guided stent placement had been performed were analyzed retrospectively. The operation time, clinical efficacy, complications and postoperative hospitalization were observed. Follow-up was scheduled at 1 and 3 months after the operation, and every 3 months thereafter, or when the patients developed clinical symptoms related to ALO. RESULTS Stent placement was performed successfully in 11 patients with an average time of 37.9 ± 12.2 min. For the other one patient, we adopted transnasal drainage tube implantation in afferent loop instead of stent placement. All the patients had an obvious relief of clinical symptoms, and no serious complications occurred. During the follow-up, 1 patient had restenosis 12 months later as the tumor grew across the stent mesh. 7 patients died of tumor progression at 3, 4.5, 5, 7, 8, 11 and 15 months after the operation. CONCLUSION Fluoroscopy guided stent placement is an effective and safe method for the treatment of malignant ALO.