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Transcholecystic Duodenal Drainage as an Alternative Decompression Method for Afferent Loop Syndrome: Two Case Reports

들장관증후군의 대체 감압 치료로서 경담낭 십이지장 배액술: 두 건의 증례 보고

  • Jihoon Hong (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Gab Chul Kim (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Jung Guen Cha (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Jongmin Park (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Byunggeon Park (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Seo Young Park (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Sang Un Kim (Department of Internal Medicine, Kyungpook National University Hospital)
  • 홍지훈 (경북대학교 의과대학 영상의학교실) ;
  • 김갑철 (경북대학교 의과대학 영상의학교실) ;
  • 차중근 (경북대학교 의과대학 영상의학교실) ;
  • 박종민 (경북대학교 의과대학 영상의학교실) ;
  • 박병건 (경북대학교 의과대학 영상의학교실) ;
  • 박서영 (경북대학교 의과대학 영상의학교실) ;
  • 김상운 (경북대학교병원 내과)
  • Received : 2023.09.15
  • Accepted : 2023.11.05
  • Published : 2024.05.01

Abstract

Afferent loop syndrome (ALS) is a rare complication of gastrectomies and gastrointestinal reconstruction. This can predispose patients to fatal conditions, such as cholangitis, pancreatitis, and duodenal perforation with peritonitis. Therefore, emergency decompression is necessary to prevent these complications. Herein, we report two cases in which transcholecystic duodenal drainage, an alternative decompression treatment, was performed in ALS patients without bile duct dilatation. Two patients who underwent distal gastrectomy with Billroth II anastomosis sought consultation in an emergency department for epigastric pain and vomiting. On CT, ALS with acute pancreatitis was diagnosed. However, biliary access could not be achieved because of the absence of bile duct dilatation. To overcome this problem, a duodenal drainage catheter was placed to decompress the afferent loop after traversing the cystic duct via a transcholecystic approach. The patients were discharged without additional surgical treatment 2 weeks and 1 month after drainage.

들장관증후군은 위장 재건술을 동반한 위절제술 후 발생하는 드문 합병증이다. 이 질환은 담관염, 췌장염, 복막염을 동반한 십이지장 천공과 같은 치명적인 상태에 이를 수 있어서, 즉각적인 감압 치료가 필요하다. 담관 확장이 없는 들장관증후군 환자를 위한 대체 감압 치료법으로 경담낭 십이지장 배액술을 시행한 두 건의 증례를 보고하고자 한다. Billroth II 문합술과 위원위절제술을 시행한 2명의 환자가 상복부 통증과 구토를 주소로 응급실에 내원하였다. 컴퓨터단층촬영에서 급성 췌장염을 동반한 들장관증후군으로 진단되었다. 담관 확장이 없어 담도를 통한 접근이 어려워, 경담낭 접근을 통해 담낭관을 통과한 후 들장관을 감압하기 위한 십이지장 배액 카테터를 설치하였다. 환자들은 배액술 시행 후 각각 2주와 1개월째에 추가적인 수술적 치료 없이 퇴원하였다.

Keywords

References

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