Afferent loop obstruction after gastric cancer surgery: helical CT findings

Kim, Hee Chan; Han, Joon Koo; Kim, K. W.; Kim, Young Hoon; Yang, Han–Kwang; Kim, Seunghyup; Won, Hyung Jin; Lee, Kyung Ho; Choi, Byung Ihn

doi:10.1007/s00261-002-0070-y

Cited by 50 publications

(40 citation statements)

References 20 publications

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“…A clear understanding of the level of obstruction and the anatomy of the bypass is essential. This may well be demonstrated by one imaging modality alone, 19,20 however as illustrated the techniques are complementary and a combination gives the most complete assessment. If the stricture is well below the bilioenteric anastomosis it may not be accessible through a transhepatic approach.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Jaundice after Bilioenteric Anastomosis: Transhepatic and Direct Percutaneous Enteral Stent Insertion for Afferent Loop Occlusion

Laasch

2010

Gut Liver

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Recurrent tumour after radical pancreaticoduodenectomy may cause obstruction of the small bowel loop draining the liver. Roux-loop obstruction presents a particular therapeutic challenge, since the postsurgical anatomy usually prevents endoscopic access. Careful multidisciplinary discussion and multimodality preprocedure imaging are essential to accurately demonstrate the cause and anatomical location of the obstruction. Transhepatic or direct percutaneous stent placement should be possible in most cases, thereby avoiding long-term external biliary drainage. Gastropexy T-fasteners will secure the percutaneous access and reduce the risk of bile leakage. The static bile is invariably contaminated by gut bacteria, and systemic sepsis is to be expected. Enteral stents are preferable to biliary stents, and compound covered stents in a sandwich construction are likely to give the best long-term results. Transhepatic and direct percutaneous enteral stent insertion after jejunopexy is illustrated and the literature reviewed. (Gut Liver 2010; 4(Suppl. 1):S89-95)

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Section: Discussionmentioning

confidence: 99%

Obstructive Jaundice after Bilioenteric Anastomosis: Transhepatic and Direct Percutaneous Enteral Stent Insertion for Afferent Loop Occlusion

Laasch

2010

Gut Liver

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“…19 Common causes of ALS are adhesions, recurrent cancer, inflammatory thickening of the anastomosis, kinking at the anastomosis, internal hernia, stoma stenosis, and inflammation surrounding the anastomosis. 20,21 Some cases of ALS progress rapidly and complications such as peritonitis may develop, which can be fatal. Mortality from these complications has been reported to be 30% to 60%.…”

Section: Discussionmentioning

confidence: 99%

Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

Kim

Lee

Kim

et al. 2016

International Surgery

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The aim of this study was to elucidate the role of percutaneous transhepatic biliary drainage (PTBD) in patients with duodenal stump leakage (DSL) and afference loop syndrome (ALS) postgastrectomy for malignancy or benign ulcer perforation. Percutaneous transhepatic biliary drainage (PTBD) is an interventional radiologic procedure used to promote bile drainage. Duodenal stump leakage (DSL) and afferent loop syndrome (ALS) can be serious complications after gastrectomy. From January 2002 through December 2014, we retrospectively reviewed 19 patients who underwent PTBD secondary to DSL and ALS postgastrectomy. In this study, a PTBD tube was placed in the proximal duodenum near the stump or distal duodenum in order to decompress and drain bile and pancreatic fluids. Nine patients with DSL and 10 patients with ALS underwent PTBD. The mean hospital stay was 34.3 days (range, 12 to 71) in DSL group and 16.4 days (range, 6 to 48) in ALS group after PTBD. A liquid or soft diet was started within 2.6 days (range, 1 to 7) in the ALS group and within 3.4 days (range, 0 to 15) in the DSL group after PTBD. One patient with DSL had PTBD changed, and 2 patients with ALS underwent additional surgical interventions after PTBD. The PTBD procedure, during which the tube was inserted into the duodenum, was well-suited for decompression of the duodenum as well as for drainage of bile and pancreatic fluids. This procedure can be an alternative treatment for cases of DSL and ALS postgastrectomy.Key words: Gastrectomy -PTBD -Duodenal stump leakage -Afferent loop syndrome P ostoperative complications after gastrectomy are difficult for both patients and surgeons. In the past, most of the major complications after gastrectomy required re-operation. The rate of reoperation for these complications ranges from 2.8% to 10%. 1-3 After gastrectomy, duodenal stump leak-

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“…[4] Where gastric carcinoma was the indication for the initial operation, [5] tumour recurrence was noted to outweigh other usual causes such as adhesions, anastomotic ulcers, stenoses, internal hernias in surgically created foraminae (including in the mesentery), twisting foci, or intussusceptions. [2,6] …”

Section: Frequency and Causesmentioning

confidence: 99%

“…The 'keyboard sign' produced by the valvulae conniventes is further supportive evidence. [5] The presence of bowel ischaemia can be determined with arterial and venous phase CT, and the detection the 'whirl sign' points to internal herniation. Seeking subtle features of adhesive obstruction such as anterior peritoneal thickening, small bowel loops closely applied to the anterior peritoneum, acute bowel loop kinks, fine mesenteric lines and bowel wall asymmetry may assist in complicated cases.…”

Section: Diagnosismentioning

confidence: 99%

Abdominal imaging: Diagnosis

Misser¹

2013

S Afr J Rad

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Afferent loop obstruction after gastric cancer surgery: helical CT findings

Abstract: Recurrent tumors and other potential causes of afferent loop obstruction can be correctly predicted with CT in most cases.

Cited by 50 publications

References 20 publications

Obstructive Jaundice after Bilioenteric Anastomosis: Transhepatic and Direct Percutaneous Enteral Stent Insertion for Afferent Loop Occlusion

Obstructive Jaundice after Bilioenteric Anastomosis: Transhepatic and Direct Percutaneous Enteral Stent Insertion for Afferent Loop Occlusion

Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

Abdominal imaging: Diagnosis

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