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

Abstract

Tumour recurrence that obstructs the afferent limb, blocking outflow of bile and pancreatic juice, constitutes a major clinical problem after a Whipple procedure. The endoscopic route is often not a possible alternative. Surgery may be difficult and perhaps dangerous to the often very sick patient and decompression with fine bore catheters may lead to cholangitis. External drainage is inconvenient to the patient. The present case describes a less invasive method to provide adequate drainage of the obstructed jejunal limb by insertion of a 22-mm enteral Wallstent transhepatically. The patient became and stayed anicteric during 7 months’ follow-up.

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

“…12,13 However permanent external drainage is a very unsatisfactory outcome, leaving the patient disfigured by a drainage bag full of bile and the carers with the challenge of maintaining it. Reports of transhepatic placement of enteral stents are rare [14][15][16][17][18] and we have only found one previous case of direct percutaneous enteral stent insertion for Roux loop obstruction. 7 With adoption of techniques used for other interventions it should be possible to achieve internal drainage in most cases, but a number of careful considerations are required.…”

Endoscopic metal enteral stent placement for malignant afferent loop syndrome after pancreaticoduodenectomy.

“…The percutaneous transhepatic route is also restricted in patients with ascites or multiple liver metastases, and passing a guidewire through the stricture of the loop is not possible every time by the percutaneous transhepatic route. In the early reports, some authors believed that, with the change and reconstruction of the upper gastrointestinal tract due to previous surgery, stent insertion by the transoral endoscopic route was not available in most cases [ 17 – 19 ]. However, due to the development of the endoscopic technique, stent placement through the peroral approach with the endoscope is adopted by more and more clinicians.…”

Percutaneous transhepatic access to allow per-oral enteric stent insertion for malignant duodenal obstruction following failed endoscopic attempt

“…Transhepatic access to facilitate enteric stenting has previously been used to treat malignant af- ferent loop obstruction following pancreaticoduodenectomy as an alternative to surgery. [5][6][7] In these cases there is no endoscopic alternative. These procedures also require the enteric stent to be introduced through the transhepatic tract, therefore necessitating a 11 to 12 French access through the liver.…”