Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Deep vein thrombosis caused by malignant afferent loop obstruction

  • Kang, Eun Gyu (Department of Internal Medicine, Hongik Hospital) ;
  • Kim, Chan (Division of Medical Oncology, Department of Internal Medicine) ;
  • Lee, Jeungeun (Division of Medical Oncology, Department of Internal Medicine) ;
  • Cha, Min-uk (Division of Medical Oncology, Department of Internal Medicine) ;
  • Kim, Joo Hoon (Division of Medical Oncology, Department of Internal Medicine) ;
  • Park, Seo-Hwa (Department of Internal Medicine, Hongik Hospital) ;
  • Kim, Man Deuk (Department of Radiology, Yonsei University College of Medicine) ;
  • Lee, Do Yun (Department of Radiology, Yonsei University College of Medicine) ;
  • Rha, Sun Young (Division of Medical Oncology, Department of Internal Medicine)
  • Received : 2015.06.19
  • Accepted : 2015.08.12
  • Published : 2016.11.18
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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 self-expanding 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.

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References

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