At the focal point| Volume 77, ISSUE 1, P132-133, January 2013

A case of acute afferent loop syndrome treated by transgastric drainage with EUS

      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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