The transhepatic route for the placement of a duodenojejunal stent: Application in a postoperative closed loop obstruction of the duodenum

Abstract

A patient who had undergone gastric resection for carcinoma, had closed loop obstruction of the duodenum due to neoplasia at the duodenojejunal junction. The obstruction was relieved successfully by transhepatic placement of a duodenojejunal stent. We were compelled to use the transhepatic route because a Roux-Y reconstruction had been performed. Transhepatic placement may be the only chance of palliation in a small subset of patients with malignant intestinal obstruction.

Transhepatic Placement of an Enteral Stent to Treat Jaundice in a Tumor Recurrence Obstructed Afferent Loop after a Whipple Procedure

“…The presented case demonstrates a new minimally invasive method to deal with the problem of jaundice after tumour recurrence around the intestine distal to the hepaticoenteric anastomosis after a Whipple procedure. The method has previously been described after recurrence of gastric cancer around the duodenum, but as the present case demonstrates, it also seems to be a useful method for dealing with tumour recurrence around the bile diverting intestine after a Whipple procedure [9]. …”

“…Decompression of the intestinal part proximal to the stenosis must be performed. One method often used is to leave a transhepatic percutaneous drain open with the obvious disadvantage of bile diversion to a plastic bag on the body surface and removal of the bile from the enteric system since many of the patients are reluctant to drink their bile [8, 9]. Another method is to perform a surgical anastomosis between the obstructed intestinal part and the small intestine.…”

Complex percutaneous biliary procedures: Review and contributions of a high volume team

“…For those patients, a duodenal stent placed per-orally, [42][43][44][45][46][47][48][49][50] through a percutaneous gastrostomy 51 or through the biliary access at the same time as the biliary stent placement is a good option. [52][53][54] Regarding the biliary access, there are two possible situations: the duodenal stenosis is distal to the papilla or proximal. In the first one, it is effortless to pass two guidewires.…”

“…Most of the articles yielded the consensus that simultaneous biliary and duodenal stenting is a safe and effective procedure. [51][52][53][54]…”