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Background <p>Recurrent malignant afferent loop obstruction (ALO) after pancreaticoduodenectomy poses significant management challenges, with conventional interventions (stents, percutaneous transhepatic cholangio drainage [PTCD], or surgery) having substantial limitations.</p> Case presentation <p>A 78-year-old man with recurrent pancreatic cancer presented with jaundice, fever, and abdominal pain 7 months post-pancreaticoduodenectomy. Imaging confirmed malignant ALO with cholangitis (CA19-9: 6772 U/mL; bilirubin: 116.4 µmol/L).</p> Intervention <p>An innovative dual-pathway drainage technique was employed: (1) A flared self-expanding metal stent (SEMS) was deployed across the afferent loop stricture under CT guidance to restore luminal continuity; (2) A 10-Fr PTCD catheter was retained long-term, inserted through a stent mesh pore (≥ 4 mm), traversing the stent lumen with its tip positioned distally in the afferent loop (“PTCD-Stent Complex”). </p> Outcomes <p>Symptoms resolved within 48 h. Bilirubin normalized (33.3 µmol/L) and inflammatory markers improved by day 7. The catheter output stabilized at 150 mL/day, confirming balanced drainage. Follow-up at 3 months showed patent drainage and resolved dilatation. The patient resumed chemotherapy, avoided re-intervention for ALO, and maintained improved quality of life (GIQLI: 33→54) until death from systemic progression at 9 months.</p> Conclusion <p>The PTCD-Stent Complex provides effective dual-pathway drainage for malignant ALO, combining immediate decompression (PTCD) with sustained internal drainage (stent). Crucially, the catheter physically preserves a functional lumen despite tumor ingrowth, significantly prolonging patency. This minimally invasive approach is a promising option for high-risk surgical patients.</p>

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PTCD-stent complex for recurrent malignant afferent loop obstruction after pancreaticoduodenectomy

  • 期刊论文

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  • 发表日期：

    2026年2月19日

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  • Dongxue Geng,
  • Yi Miao,
  • Jingjing Tao

摘要

Background

Recurrent malignant afferent loop obstruction (ALO) after pancreaticoduodenectomy poses significant management challenges, with conventional interventions (stents, percutaneous transhepatic cholangio drainage [PTCD], or surgery) having substantial limitations.

Case presentation

A 78-year-old man with recurrent pancreatic cancer presented with jaundice, fever, and abdominal pain 7 months post-pancreaticoduodenectomy. Imaging confirmed malignant ALO with cholangitis (CA19-9: 6772 U/mL; bilirubin: 116.4 µmol/L).

Intervention

An innovative dual-pathway drainage technique was employed: (1) A flared self-expanding metal stent (SEMS) was deployed across the afferent loop stricture under CT guidance to restore luminal continuity; (2) A 10-Fr PTCD catheter was retained long-term, inserted through a stent mesh pore (≥ 4 mm), traversing the stent lumen with its tip positioned distally in the afferent loop (“PTCD-Stent Complex”).

Outcomes

Symptoms resolved within 48 h. Bilirubin normalized (33.3 µmol/L) and inflammatory markers improved by day 7. The catheter output stabilized at 150 mL/day, confirming balanced drainage. Follow-up at 3 months showed patent drainage and resolved dilatation. The patient resumed chemotherapy, avoided re-intervention for ALO, and maintained improved quality of life (GIQLI: 33→54) until death from systemic progression at 9 months.

Conclusion

The PTCD-Stent Complex provides effective dual-pathway drainage for malignant ALO, combining immediate decompression (PTCD) with sustained internal drainage (stent). Crucially, the catheter physically preserves a functional lumen despite tumor ingrowth, significantly prolonging patency. This minimally invasive approach is a promising option for high-risk surgical patients.