Self-expanding metal stent procedure for afferent loop syndrome with ascending cholangitis caused by remnant gastric cancer: A case report.

RATIONALE: Self-expanding metal stent placement is a useful procedure for intestinal obstruction. Afferent loop syndrome after gastrectomy is an uncommon complication of gastroenterostomy reconstruction. Ascending cholangitis caused by afferent loop syndrome is a potential, but rare, complication. PATIENT CONCERNS: A 73-year-old man with abdominal pain and vomiting was admitted to the emergency room. His medical history was significant for subtotal gastrectomy with Billroth II anastomosis for benign gastric ulcer perforation 40 years prior. He had notable tenderness to palpation, particularly on the epigastric area, and a temperature of 39.0°C. DIAGNOSIS: Abdominal computed tomography revealed afferent loop syndrome with ascending cholangitis caused by remnant gastric cancer. INTERVENTIONS: Percutaneous catheter drainage for management of ascending cholangitis was performed on the day of admission. He was subsequently treated with self-expandable metal stent insertion into the stenotic lesion. OUTCOMES: After treatment with percutaneous transhepatic insertion of a self-expanding stent, the patient achieved complete resolution of symptoms. The patient died of disease progression 2 months later, without further recurrence of afferent loop syndrome. LESSONS: Our case shows that insertion of a metal stent via percutaneous transhepatic biliary drainage (PTBD) can effectively treat ascending cholangitis and resolve afferent loop syndrome in inoperable patients.

Tuberculous bronchonodal fistula in adult patients: CT findings.

PURPOSE: To describe the computed tomography (CT) findings of bronchonodal fistulas occurring in seven adult patients with active pulmonary tuberculosis (TB). MATERIALS AND METHODS: Seven patients with confirmed tuberculous bronchonodal fistula who underwent chest CT scans were enrolled. The patient demographics and CT and bronchoscopic findings were analyzed. The bronchonodal fistula site, distribution and characteristics of the involved lymph nodes, airway change, and parenchymal lesions found on CT were reviewed. RESULTS: The seven patients comprised four males and three females. All patients were over 70 years old (range 72-85 years; mean age 78 years). The site of occurrence of the bronchonodal fistula was on the right side between the lobar bronchi and paratracheal or hilar lymph nodes in five patients and on the left side between the left main bronchus and subcarinal lymph nodes in two patients. The involved lymph nodes were necrotic in four patients and necrotic with partial calcification in three. In all patients, active pulmonary TB lesions involving multiple lobes were found as consolidations (n = 3), poorly defined nodules (n = 4), cavities (n = 1), or centrilobular nodules exhibiting tree-in-bud appearance (n = 7). CONCLUSION: Bronchonodal fistula can occur as a complication of active pulmonary TB with TB lymphadenitis in adult patients, especially in the elderly. The fistulas usually involved the right side. The lobar bronchus was frequently involved on the right side and the main bronchus on the left side.