Bile Duct Drainage Using a Short Double-Balloon Endoscope for a Hematoma due to Hepatocellular Carcinoma After Roux-en-Y Reconstruction

Abstract

An 84-year-old male six years status post total gastrectomy with a Roux-en-Y reconstruction for the treatment of gastric cancer (Stage II) presented with a three-day history of fever (40.0℃) and jaundice. He also had cirrhosis secondary to hepatitis C infection. His local physician suspected obstructive jaundice and cholangitis caused by choledocholithiasis based on laboratory findings and magnetic resonance imaging. He was treated with antibiotics (Tazobactam/ Piperacillin hydrate), and transferred to our institution for further treatment.On admission, he presented with a low-grade fever (37.2℃) and ABSTRACTAn 84-year-old male status post Roux-en-Y anastomosis and cirrhosis presented with fever and jaundice. Double-balloon endoscopy showed bleeding from the papilla of Vater and endoscopic retrograde cholangiopancreatography was performed. Cholangiography revealed an intraductal filling defect due to blood clots probably caused by bleeding from the hepatocellular carcinoma. Placement of an endoscopic nasobiliary drainage tube relieved the jaundice and cholangitis. Subsequent transarterial chemoembolization for hepatocellular carcinoma was performed to control the bleeding. After removal of the tube, he was discharged. The patient developed obstructive jaundice caused by a hepatocellular carcinoma. A short double-balloon endoscope with a 2.8 mm working channel enabled metal stent placement. Double-balloon ERCP enabled biliary drainage in a patient with surgically altered anatomy and cirrhosis, and provided effective relief of symptoms. CASE REPORT