倉科 憲太郎

A 65-year-old man with gastric cancer and renal cell carcinoma underwent total gastrectomy with a Roux-en Y reconstruction and left nephrectomy. Two years postoperatively, the patient developed septic shock due to afferent loop syndrome caused by adhesions near the nephrectomy site. His afferent loop symptoms worsened over time, and his general condition deteriorated prior to admission. We performed a direct percutaneous endoscopic duodenostomy (D-PED) using double-balloon endoscopy (DBE) to drain the dilated afferent limb and simultaneously feed the patient via the efferent limb using a double lumen gastro-jejunostomy tube. His overall condition improved after the D-PED, and he underwent a duodeno-jejunal bypass three months later. DBE is feasible even at the duodenal stump after a Roux-en-Y reconstruction. This is the first report of a D-PED with DBE.