Limits...
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

Sequences of tube cholangiography. (A) and (B) Direct cholangiogram through the PTBD tube showed uneventful filling of the intrahepatic duct and hepaticojejunostomy, but outflow passage at 5 minutes was impaired; and (C) and (D) Balloon dilation of the afferent jejunal loop was performed by using a 20 mm- wide balloon and a large-bore catheter was placed deep into the afferent jejunal loop.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4494079&req=5

Figure 5: Sequences of tube cholangiography. (A) and (B) Direct cholangiogram through the PTBD tube showed uneventful filling of the intrahepatic duct and hepaticojejunostomy, but outflow passage at 5 minutes was impaired; and (C) and (D) Balloon dilation of the afferent jejunal loop was performed by using a 20 mm- wide balloon and a large-bore catheter was placed deep into the afferent jejunal loop.

Mentions: The patient recovered uneventfully without any surgical complication. At 14 days after surgery, the replaced PTBD tube was test-clamped for removal. On the day after test-clamping, cholangitis happened unexpectedly. Hepatobiliary scintigraphy showed a 16% excretion rate at 90 minutes, implicating significant outflow disturbance (Fig. 4A). Direct cholangiography through the PTBD tube showed uneventful filling of the intrahepatic duct and hepaticojejunostomy, but a passage into the jejunal limb was significantly impaired (Fig. 5A, B).


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)

Sequences of tube cholangiography. (A) and (B) Direct cholangiogram through the PTBD tube showed uneventful filling of the intrahepatic duct and hepaticojejunostomy, but outflow passage at 5 minutes was impaired; and (C) and (D) Balloon dilation of the afferent jejunal loop was performed by using a 20 mm- wide balloon and a large-bore catheter was placed deep into the afferent jejunal loop.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Sequences of tube cholangiography. (A) and (B) Direct cholangiogram through the PTBD tube showed uneventful filling of the intrahepatic duct and hepaticojejunostomy, but outflow passage at 5 minutes was impaired; and (C) and (D) Balloon dilation of the afferent jejunal loop was performed by using a 20 mm- wide balloon and a large-bore catheter was placed deep into the afferent jejunal loop.
Mentions: The patient recovered uneventfully without any surgical complication. At 14 days after surgery, the replaced PTBD tube was test-clamped for removal. On the day after test-clamping, cholangitis happened unexpectedly. Hepatobiliary scintigraphy showed a 16% excretion rate at 90 minutes, implicating significant outflow disturbance (Fig. 4A). Direct cholangiography through the PTBD tube showed uneventful filling of the intrahepatic duct and hepaticojejunostomy, but a passage into the jejunal limb was significantly impaired (Fig. 5A, B).

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