Case Report
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World J Gastroenterol. Mar 14, 2014; 20(10): 2721-2724
Published online Mar 14, 2014. doi: 10.3748/wjg.v20.i10.2721
Pancreaticoduodenectomy following total gastrectomy: A case report and literature review
Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato
Satoshi Yokoyama, Akinori Sekioka, Kohei Ueno, Yasuhiro Higashide, Yuko Okishio, Nao Kawaguchi, Takeshi Hagihara, Harumi Yamada, Ryo Kamimura, Michio Kuwahara, Masato Ichimiya, Hirofumi Utsunomiya, Shiro Uyama, Hiroaki Kato, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama 640-8558, Japan
Author contributions: Yokoyama S designed the report; Yokoyama S, Sekioka A, Ueno K, Higaside Y, Okishio Y, Kawaguchi N, Hagihara T, Yamada H, Kamimura R, Kuwahara M, Ichimiya M, Utsunimiya H and Kato H were attending doctors for the patient; Yokoyama S, Sekioka S, Ueno K, Higashide Y and Uyama S performed the operation; Yokoyama S was responsible for this patient in the outpatient clinic; Uyama S organized the report; Yokoyama S wrote the manuscript.
Correspondence to: Satoshi Yokoyama, MD, Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama 640-8558, Japan. yokoyama.st@gmail.com
Telephone: +81-73-4224171 Fax: +81-73-4261168
Received: October 4, 2013
Revised: November 1, 2013
Accepted: November 28, 2013
Published online: March 14, 2014
Processing time: 158 Days and 20.9 Hours
Abstract

We present a case of afferent loop syndrome (ALS) occurring after pancreaticoduodenectomy (PD) in a patient who had previously undergone total gastrectomy (TG), and review the English-language literature concerning reconstruction procedures following PD in patients who had undergone TG. The patient was a 69-year-old man who had undergone TG reconstruction by a Roux-en-Y method at age 58 years. The patient underwent PD for pancreas head adenocarcinoma. A jejunal limb previously made at the prior TG was used for pancreaticojejunostomy and hepaticojejunostomy. Despite normal patency of the hepaticojejunostomy, he suffered from repeated postoperative cholangitis which was brought on by ALS due to shortness of the jejunal limb (15 cm in length). We therefore performed receliotomy in which the hepaticojejunostomy was disconnected and reconstructed using a new Y limb 40-cm in length constructed in a double Roux-en-Y fashion. The refractory cholangitis resolved immediately after the receliotomy and did not recur. Review of the literature revealed the lack of any current consensus for a standard procedure for reconstruction following PD in patients who had previously undergone TG. This issue warrants further attention, particularly given the expected future increase in the number of PDs in patients with a history of gastric cancer.

Keywords: Pancreaticoduodenectomy following total gastrectomy; Afferent loop syndrome after pancreaticoduodenectomy

Core tip: We present a case of afferent loop syndrome occurring after pancreaticoduodenectomy (PD) in a patient who had previously undergone total gastrectomy, and review the English-language literature concerning reconstruction procedures following PD in patients who had undergone total gastrectomy (TG). Review of the literature revealed the lack of any current consensus for a standard procedure for reconstruction following PD in patients who had previously undergone TG. This issue warrants further attention, particularly given the expected future increase in the number of PDs in patients with a history of gastric cancer.