Percutaneously assisted EUS-guided gastrojejunostomy for the treatment of afferent limb syndrome

摘要

A 72-year-old woman with a medical history of pancreatic adenocarcinoma status after pancreatoduodenectomyand adjuvant therapy with chemoradiotherapy presentedwith fever and jaundice 17 months after undergoingpancreatoduodenectomy. She underwent CT scan of theabdomen without contrast medium, which showed dilatation of the afferent loop and dilatation of the intrahepaticand extrahepatic ducts suggestive of afferent limb syndrome. The radiologic findings were also highly suggestive of pancreatic cancer recurrence. ERCP could not beperformed at an outside hospital because of a highgrade stricture at the afferent limb. Percutaneous biliarydrainage was placed. Endoscopic evaluation revealed anontraversable stricture, 10 cm long, at the afferentlimb.