An 80-year-old woman was admitted to our hospital with fever, epigastric pain, and
vomiting. Six months earlier, she had undergone pancreaticoduodenectomy for GI obstruction
caused by duodenal cancer. Her laboratory data on admission were as follows: white
blood cell count, 17,080/μL (normal range, 4300-5800/μL); total bilirubin, 1.33 mg/dL
(normal range, 0.33-1.28 mg/dL); aspartate aminotransferase, 103 U/L (normal range,
10-35 U/L); alanine aminotransferase, 56 U/L (normal range, 7-42 U/L); alkaline phosphatase,
922 U/L (normal range, 110-360 U/L); and C-reactive protein, 3.61 mg/L (normal range,
0.0-0.3 mg/L). A CT scan (A) revealed dilatation of the afferent loop, and enhancement of the soft tissue around
the celiac artery and stump stomach because of a recurrence of cancer. The efferent
loop was normal. The intrahepatic bile duct was not dilated. We punctured across the
stomach into the dilated afferent loop with a 19-gauge needle under EUS guidance and
inserted two 7F Zimmon-type plastic stents (B, C). After stent placement, the expanded afferent loop showed a reduction in size on
CT scan (D), and the laboratory results and clinical status improved. There were no complications,
and the patient was discharged from our hospital in good general condition.
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Lawrence J. Brandt, MD, Associate Editor for Focal Points
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© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
