Published online Dec 15, 2013. doi: 10.4251/wjgo.v5.i12.235
Revised: November 12, 2013
Accepted: November 18, 2013
Published online: December 15, 2013
Processing time: 91 Days and 0.7 Hours
Pancreatic cancer is an aggressive malignancy potentially curable with surgical intervention. Following pancreaticoduodenectomy for suspected pancreatic head malignancy, patients have a high risk for both immediate and delayed problems due to surgical complications and recurrent disease. We report here a patient with pancreatic cancer treated with pancreaticoduodenectomy who developed recurrent disease resulting in obstruction of the afferent limb. The patient developed biliary obstruction and cholangitis at presentation. Her biliary tree failed to dilate which precluded safe percutaneous biliary decompression. During surgical exploration, she was found to have a dilated afferent limb at the level of the transverse mesocolon. The patient underwent decompression of the afferent limb as well as the biliary tree using a venting gastrojejunostomy to the blind loop. This represents a novel surgical approach for management of this complicated and difficult problem.
Core tip: Complications from recurrent pancreatic cancer can result in afferent loop obstruction. This leads to stasis of the biliary, intestinal and pancreatic secretions. We present here a unique approach to manage afferent loop obstruction caused by recurrent peritoneal metastases from pancreatic cancer. The patient underwent decompression of the afferent limb as well as the biliary tree using a venting gastrojejunostomy to the blind loop. This represents a novel surgical approach for management of this complicated and difficult problem.