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Balloon dilation of jejunal afferent loop functional stenosis following left hepatectomy and hepaticojejunostomy long time after pylorus-preserving pancreaticoduodenectomy: a case report.

Yoon YI, Hwang S, Ko GY, Lee JJ, Kang CM, Seo JH, Kwon YJ, Cheon SJ - Korean J Hepatobiliary Pancreat Surg (2015)

Bottom Line: The patient recovered uneventfully, but clamping of the percutaneous transhepatic biliary drainage (PTBD) tube resulted in cholangitis.Biliary imaging studies revealed that biliary passage into the afferent jejunal limb was significantly impaired.This very unusual condition was regarded as disuse atrophy of the jejunal loop, which was successfully managed by balloon dilation and intraluminal keeping of a large-bore PTBD tube for 1 month.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
We present a rare case of functional stenosis of the jejunal loop following left hepatectomy and hepaticojejunostomy long after pylorus-preserving pancreaticoduodenectomy (PPPD), which was successfully managed by balloon dilation. A 70-year-old Korean man had undergone PPPD 6 years before due to 1.8 cm-sized distal bile duct cancer. Sudden onset of obstructive jaundice led to diagnosis of recurrent bile duct cancer mimicking perihilar cholangiocarcinoma of type IIIb. After left portal vein embolization, the patient underwent resection of the left liver and caudate lobe and remnant extrahepatic bile duct. The pre-existing jejunal loop and choledochojejunostomy site were used again for new hepaticojejunostomy. The patient recovered uneventfully, but clamping of the percutaneous transhepatic biliary drainage (PTBD) tube resulted in cholangitis. Biliary imaging studies revealed that biliary passage into the afferent jejunal limb was significantly impaired. We performed balloon dilation of the afferent jejunal loop by using a 20 mm-wide balloon. Follow-up hepatobiliary scintigraphy showed gradual improvement in biliary excretion and the PTBD tube was removed at 1 month after balloon dilation. This very unusual condition was regarded as disuse atrophy of the jejunal loop, which was successfully managed by balloon dilation and intraluminal keeping of a large-bore PTBD tube for 1 month.

No MeSH data available.


Related in: MedlinePlus

The preoperative assessment process. (A) The postoperative status following pylorus-preserving pancreaticoduodenectomy (PPPD) was visible on the computed tomography (CT) scan; (B) Recurrent bile duct cancer mimicked perihilar cholangiocarcinoma of type IIIb on magnetic resonance cholangiography; and (C) and (D) Cholangioscopic biopsy was attempted for tissue confirmation.
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Figure 1: The preoperative assessment process. (A) The postoperative status following pylorus-preserving pancreaticoduodenectomy (PPPD) was visible on the computed tomography (CT) scan; (B) Recurrent bile duct cancer mimicked perihilar cholangiocarcinoma of type IIIb on magnetic resonance cholangiography; and (C) and (D) Cholangioscopic biopsy was attempted for tissue confirmation.

Mentions: A 70-year-old Korean man had undergone PPPD 6 years before due to 1.8 cm-sized well differentiated adenocarcinoma of the distal bile duct (T3N0M0 lesion) (Fig. 1A). One month before admission, he suffered from obstructive jaundice and workup led to the diagnosis of recurrent bile duct cancer mimicking perihilar cholangiocarcinoma of type IIIb (Fig. 1B). Cholangioscopic biopsy through the percutaneous transhepatic biliary drainage (PTBD) tract showed the presence of atypical cell clusters in the ulcer debris (Fig. 1C, D), suggestive of adenocarcinoma. Thus late tumor recurrence was highly suspected. Thus we decided to perform resection of the left liver and caudate lobe as well as resection of the residual bile duct with a curative intent.


Balloon dilation of jejunal afferent loop functional stenosis following left hepatectomy and hepaticojejunostomy long time after pylorus-preserving pancreaticoduodenectomy: a case report.

Yoon YI, Hwang S, Ko GY, Lee JJ, Kang CM, Seo JH, Kwon YJ, Cheon SJ - Korean J Hepatobiliary Pancreat Surg (2015)

The preoperative assessment process. (A) The postoperative status following pylorus-preserving pancreaticoduodenectomy (PPPD) was visible on the computed tomography (CT) scan; (B) Recurrent bile duct cancer mimicked perihilar cholangiocarcinoma of type IIIb on magnetic resonance cholangiography; and (C) and (D) Cholangioscopic biopsy was attempted for tissue confirmation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494079&req=5

Figure 1: The preoperative assessment process. (A) The postoperative status following pylorus-preserving pancreaticoduodenectomy (PPPD) was visible on the computed tomography (CT) scan; (B) Recurrent bile duct cancer mimicked perihilar cholangiocarcinoma of type IIIb on magnetic resonance cholangiography; and (C) and (D) Cholangioscopic biopsy was attempted for tissue confirmation.
Mentions: A 70-year-old Korean man had undergone PPPD 6 years before due to 1.8 cm-sized well differentiated adenocarcinoma of the distal bile duct (T3N0M0 lesion) (Fig. 1A). One month before admission, he suffered from obstructive jaundice and workup led to the diagnosis of recurrent bile duct cancer mimicking perihilar cholangiocarcinoma of type IIIb (Fig. 1B). Cholangioscopic biopsy through the percutaneous transhepatic biliary drainage (PTBD) tract showed the presence of atypical cell clusters in the ulcer debris (Fig. 1C, D), suggestive of adenocarcinoma. Thus late tumor recurrence was highly suspected. Thus we decided to perform resection of the left liver and caudate lobe as well as resection of the residual bile duct with a curative intent.

Bottom Line: The patient recovered uneventfully, but clamping of the percutaneous transhepatic biliary drainage (PTBD) tube resulted in cholangitis.Biliary imaging studies revealed that biliary passage into the afferent jejunal limb was significantly impaired.This very unusual condition was regarded as disuse atrophy of the jejunal loop, which was successfully managed by balloon dilation and intraluminal keeping of a large-bore PTBD tube for 1 month.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
We present a rare case of functional stenosis of the jejunal loop following left hepatectomy and hepaticojejunostomy long after pylorus-preserving pancreaticoduodenectomy (PPPD), which was successfully managed by balloon dilation. A 70-year-old Korean man had undergone PPPD 6 years before due to 1.8 cm-sized distal bile duct cancer. Sudden onset of obstructive jaundice led to diagnosis of recurrent bile duct cancer mimicking perihilar cholangiocarcinoma of type IIIb. After left portal vein embolization, the patient underwent resection of the left liver and caudate lobe and remnant extrahepatic bile duct. The pre-existing jejunal loop and choledochojejunostomy site were used again for new hepaticojejunostomy. The patient recovered uneventfully, but clamping of the percutaneous transhepatic biliary drainage (PTBD) tube resulted in cholangitis. Biliary imaging studies revealed that biliary passage into the afferent jejunal limb was significantly impaired. We performed balloon dilation of the afferent jejunal loop by using a 20 mm-wide balloon. Follow-up hepatobiliary scintigraphy showed gradual improvement in biliary excretion and the PTBD tube was removed at 1 month after balloon dilation. This very unusual condition was regarded as disuse atrophy of the jejunal loop, which was successfully managed by balloon dilation and intraluminal keeping of a large-bore PTBD tube for 1 month.

No MeSH data available.


Related in: MedlinePlus