[Percutaneous Transhepatic Cholangiodrainage to Alleviate Symptoms of Afferent Loop Obstruction--A Case Report]

The patient, a 78-year-old man, had undergone distal gastrectomy for a gastric ulcer 35 years previously. As melena was observed, he was referred to our department, and was subsequently diagnosed with residual gastric cancer and ascending colon cancer. Peritoneal metastasis of gastric cancer was found, and palliative surgeries, including right hemicolectomy, total gastrectomy, and Roux-en-Y reconstruction were performed. Although postoperative chemotherapy was commenced, side effects led to a decreased performance status (PS), which resulted in the patient shifting to the best supportive care (BSC). Five months after surgery, the patient was urgently transferred to the hospital with upper abdominal pain, and underwent computed tomography (CT) scan. The patient was diagnosed with acute afferent loop obstruction due to peritoneal metastases. It was not possible to perform endoscopic drainage because of the stenosis; therefore, percutaneous transhepatic cholangiodrainage (PTCD) was performed to reduce the pressure in the duodenal afferent loop. Herein, we report on a case of afferent loop obstruction, for which we performed decompression of the afferent loop with PTCD, allowing the patient to continue BSC for approximately 3 months.