We present a rare case of functional
stenosis of the jejunal loop following left
hepatectomy and hepaticojejunostomy long after pylorus-preserving
pancreaticoduodenectomy (PPPD), which was successfully managed by balloon dilation. A 70-year-old Korean man had undergone PPPD 6 years before due to 1.8 cm-sized distal
bile duct cancer. Sudden onset of
obstructive jaundice led to diagnosis of recurrent
bile duct cancer mimicking
perihilar cholangiocarcinoma of type IIIb. After left portal vein embolization, the patient underwent resection of the left liver and caudate lobe and remnant extrahepatic bile duct. The pre-existing jejunal loop and
choledochojejunostomy site were used again for new hepaticojejunostomy. The patient recovered uneventfully, but clamping of the percutaneous transhepatic biliary drainage (
PTBD) tube resulted in
cholangitis. Biliary imaging studies revealed that biliary passage into the afferent jejunal limb was significantly impaired. We performed balloon dilation of the afferent jejunal loop by using a 20 mm-wide balloon. Follow-up hepatobiliary scintigraphy showed gradual improvement in biliary excretion and the
PTBD tube was removed at 1 month after balloon dilation. This very unusual condition was regarded as
disuse atrophy of the jejunal loop, which was successfully managed by balloon dilation and intraluminal keeping of a large-bore
PTBD tube for 1 month.