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

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.