We presented a rare case of chronic afferent loop obstruction after radical resection of gastric carcinoma. A 44-year-old man was admitted because of "upper abdominal distension and abdominal pain for 3 months, skin and sclera jaundice for 2 weeks". Abdominal CT revealed dilatation of the intrahepatic bile duct and common bile duct, a large, abdominal cystic lesion, as well as left adrenal gland metastasis. MRCP revealed that the cystic lesion was an expansion of loops. Thus, the diagnosis of afferent loop (A-loop) obstruction was made. Subsequently, the patient underwent percutaneous transhepatic cholangial drainage (PTCD). The patient's abdominal pain was significantly reduced, and the jaundice subsided. We should consider the possibility of the occurrence of the left adrenal metastasis and abdominal lymph node metastasis led to a chronic obstruction of A-loop. The chronic obstruction gradually developed into a complete blockage, further causing biliary obstruction and resulting in the occurrence of severe jaundice and abdominal pain. Here we not only reported a case of chronic afferent loop obstruction following radical resection of gastric carcinoma, but also analyzed the characteristic features of CT imaging and treatment. This case report is a good reference to similar gastrointestinal malignancy. Keywords: Percutaneous trans hepatic cholangial drainage; Afferent loop obstruction Case ReportA 44-year-old man presented with 1-month progressive jaundice, as well as 3-month upper abdominal distension and abdominal pain. He had undergone an "extended radical resection for gastric carcinoma (total gastrectomy, Roux-en-Y anastomosis, distal pancreatectomy, and splenectomy and cholecystectomy)" due to gastric cancer three years ago. Physical examination revealed poor vitality, severe jaundice of the skin and sclera, a soft and movable mass in the upper abdomen. Laboratory examinations showed red blood cell (RBC) 3.0 × 10 9 /L, hemoglobin (HB) 76 g/L, total bilirubin (TBIL) 187.7 µmol/L, albumin (ALB) 26.8 g/L, direct bilirubin (DBIL) 161.5 µmol/L, alkaline phosphatase (ALP) 99 IU/L. The results of tumor markers were as follows: carbohydrate antigen 19-9 (CA199) 80.82 ng/ml, carcinoembryonic antigen (CEA) 5.8 ng/ml. Abdominal CT revealed dilatation of the intrahepatic bile duct and common bile duct, a large, abdominal cystic lesion ( Figure 1A), as well as left adrenal gland metastasis ( Figure 1B).The patient was diagnosed at first with malignant obstructive jaundice. However, what is the reason for biliary obstruction? To investigate the site and cause of bile duct obstruction, we performed Magnetic Resonance Cholangiopancreatography (MRCP) examination. MRCP revealed that the cystic lesion was an expansion of small bowel loops ( Figure 1C). Thus, the diagnosis of afferent loop (A-loop) obstruction was made. Subsequently, the patient underwent percutaneous transhepatic cholangial drainage (PTCD). The duodenal-jejunal anastomotic stricture (Figure 2A) was observed. Taken together, an accurate diagnosis for...