Deep vein thrombosis caused by malignant afferent loop obstruction
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Afferent loop obstruction following gastrectomy is a rare but fatal complication. Clinical features of afferent loop obstruction are mainly gastrointestinal symptoms. A 56-year-old female underwent radical total gastrectomy with Roux-en-Y esophagojejunostomy for treatment of advanced gastric cancer. After fourteen months postoperatively, she showed gradual development of edema of both legs. Computed tomography (CT) scan showed disease progression at the jejunojejunostomy site and consequent dilated afferent loop, which resulted in inferior vena cava (IVC) compression. A drainage catheter was placed percutaneously into the afferent loop through the intrahepatic duct and an IVC filter was placed at the suprarenal IVC, and selfexpanding metal stents were inserted into bilateral common iliac veins. With these procedures, sympotms related with afferent loop obstruction and deep vein thrombosis were improved dramatically. The follow-up abdominal CT scan was taken 3 weeks later and revealed the completely decompressed afferent loop and improved IVC patency. Surgical treatment should be considered as the first choice for afferent loop obstruction; however, because it is more immediate and less invasive, non-surgical modalities, such as percutaneous catheter drainage or stent placement, can be effective alternatives for inoperable cases or risky patients who have severe medical comorbidities.
Abstract
Afferent loop obstruction following gastrectomy is a rare but fatal complication. Clinical features of afferent loop obstruction are mainly gastrointestinal symptoms. A 56-year-old female underwent radical total gastrectomy with Roux-en-Y esophagojejunostomy for treatment of advanced gastric cancer. After fourteen months postoperatively, she showed gradual development of edema of both legs. Computed tomography (CT) scan showed disease progression at the jejunojejunostomy site and consequent dilated afferent loop, which resulted in inferior vena cava (IVC) compression. A drainage catheter was placed percutaneously into the afferent loop through the intrahepatic duct and an IVC filter was placed at the suprarenal IVC, and selfexpanding metal stents were inserted into bilateral common iliac veins. With these procedures, sympotms related with afferent loop obstruction and deep vein thrombosis were improved dramatically. The follow-up abdominal CT scan was taken 3 weeks later and revealed the completely decompressed afferent loop and improved IVC patency. Surgical treatment should be considered as the first choice for afferent loop obstruction; however, because it is more immediate and less invasive, non-surgical modalities, such as percutaneous catheter drainage or stent placement, can be effective alternatives for inoperable cases or risky patients who have severe medical comorbidities.
참고문헌 (14)
- Han K, "Afferent loop syndrome: treatment by means of the placement of dual stents", Am J Roentgenol, 199, pp.W761~W766 (2012)
- Jordan GL Jr., "Surgical management of postgastrectomy problems", Arch Surg, 102, pp.251~259 (1971)
- Aoki M, "Afferent loop obstruction after distal gastrectomy with Roux-en-Y reconstruction", World J Surg, 34, pp.2389~2392 (2010)
- Mitty Jr WF, "Chronic afferent loop syndrome", Ann Surg, 172, pp.996~1001 (1970)
- Woodfield CA, "The postoperative stomach", Eur J Radiol, 53, pp.341~352 (2005)
- Wise SW., "Case 24: afferent loop syndrome 1", Radiology, 216, pp.142~145 (2000)
- Aimoto T, "Malignant afferent loop obstruction following pancreaticoduodenectomy:report of two cases", J Nippon Med Sch, 73, pp.226~230 (2006)
- Gayer G, "CT diagnosis of afferent loop syndrome", Clin Radiol, 57, pp.835~839 (2002)
- Kim HC, "Afferent loop obstruction after gastric cancer surgery: helical CT findings", Abdom Imaging, 28, pp.624~630 (2003)
- Warrier RK, "Afferent loop obstruction presenting as obstructive jaundice", Dig Dis Sci, 24, pp.74~76 (1979)
- Vettoretto N, "Laparoscopy in afferent loop obstruction presenting as acute pancreatitis", JSLS, 10, pp.270~274 (2006)
- Hosokawa I, "Percutaneous transhepatic metallic stent insertion for malig nant afferent loop obstruction following pancreaticoduodenectomy:a case report", J Med Case Rep, 6, pp.198~ (2012)
- Kim YH, "Palliative percutaneous tube enterostomy in afferent-loop syndrome presenting as jaundice: clinical effectiveness", J Vasc Interv Radiol, 13, pp.845~849 (2002)
- Song HY, "Metallic stent placement in patients with recurrent cancer after gastrojejunostomy", J Vasc Interv Radiol, 18, pp.1538~1546 (2007)