Endoscopy 2018; 50(04): S85
DOI: 10.1055/s-0038-1637280
ESGE Days 2018 oral presentations
21.04.2018 – Video session 2
Georg Thieme Verlag KG Stuttgart · New York

OBSTRUCTIVE JAUNDICE SECONDARY TO “AFFERENT LOOP SYNDROME” IN A PATIENT WITH ENDOSCOPIC GASTROJEJUNOSTOMY RESOLVED BY EUS-GUIDED HEPATICOGASTROSTOMY

DF Gómez Nussbaumer
1   Hospital General Universitario de Alicante, Alicante, Spain
,
J Martinez Sempere
1   Hospital General Universitario de Alicante, Alicante, Spain
,
L Compañy Catala
2   Endoscopy, Hospital General Universitario de Alicante, Alicante, Spain
,
JA Casellas Valde
2   Endoscopy, Hospital General Universitario de Alicante, Alicante, Spain
,
FA Ruiz
2   Endoscopy, Hospital General Universitario de Alicante, Alicante, Spain
,
O Murcia Pomares
2   Endoscopy, Hospital General Universitario de Alicante, Alicante, Spain
,
K Cardenas Jaen
2   Endoscopy, Hospital General Universitario de Alicante, Alicante, Spain
,
C Mangas Sanjuan
2   Endoscopy, Hospital General Universitario de Alicante, Alicante, Spain
,
JI Cameo
2   Endoscopy, Hospital General Universitario de Alicante, Alicante, Spain
,
M Bozhychko
2   Endoscopy, Hospital General Universitario de Alicante, Alicante, Spain
,
S Baile
1   Hospital General Universitario de Alicante, Alicante, Spain
,
L Medina
1   Hospital General Universitario de Alicante, Alicante, Spain
,
J Ramón Aparicio Tormo
1   Hospital General Universitario de Alicante, Alicante, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Introduction:

In the afferent loop syndrome there is an accumulation of bile that distends the obstructed afferent loop as a complication of gastrointestinal surgery. Obstructive jaundice in these cases is a consequence of the difficulty of draining the bile due to hyperpressure in the afferent loop. We present a case of obstructive jaundice secondary to obstruction of the second portion of the duodenum due to stenosis at the tip of the bulb and third portion of the duodenum.

Clinical case:

A 76-year-old woman diagnosed with adenocarcinoma in the head of the pancreas in April 2016, was considered unresectable due to comorbidity and presence of ascites, with drainage of the bile duct through rendezvous guided by EUS due to the impossibility of cannulating the papilla. In December 2016, she was readmitted due to secondary vomiting from the stenosis in the third duodenal portion. A duodenal prosthesis is placed, but it does not function, migrating to the stomach during a revision gastroscopy. Gastrojejunostomy was performed using Hot Axios prosthesis of 15 × 10 mm guided by USE. The patient restarts normal diet with good tolerance and is discharged. In June 2017 she is readmitted with jaundice and cholangitis. The abdomen CT shows a segment of distended duodenum. Revision of biliary prosthesis is requested using ERCP. Endoscopically, stenosis is observed in the duodenal bulb that prevents the endoscope from passing, so EUS is performed, showing ascites and dilation of the intrahepatic bile duct. A left biliary canalicul is punctured. The cholangiography shows passage of contrast to the segment of the distended duodenum. EUS- hepaticogastrostomy is performed with resolution of jaundice and infectious disease.

Conclusions:

We present the case because of the rarity of the cause of jaundice due to a mechanism similar to the afferent loop syndrome and how EUS- hepaticogastrostomy resolved it.