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- W2953371843 abstract "Background: A 77 yo F with a history of a remote jejunoileal bypass (JIB) for morbid obesity presented with obstructive jaundice, diarrhea and weight loss. Abdominal and pelvic CT showed biliary dilation and a poorly defined mass in the distal bile duct without evidence of metastatic disease as well as several loops of atretic small bowel consistent with JIB. Endoscopy with ERCP revealed a stricture of the common bile duct which was stented and brushings were consistent with adenocarcinoma. On exploration, a dilated proximal jejunum was found anastomosed end to side to the terminal ileum. Following an uncomplicated resection, the pancreatic remnant and common hepatic duct were anastomosed to the dilated, functional jejunal limb. Reversal of JIB and conversion to biliopancreatic diversion were considered. Instead, a duodenojejunostomy was constructed to the previously defunctionalized intestine and a jejunojejunostomy was constructed between the pancreatobiliary limb and the alimentary limb. (See Figure) Final pathology revealed a T3N0 poorly-differentiated adenocarcinoma of the bile duct. Postoperative recovery was prolonged requiring supplemental tube feeding for one month but the patient was eventually nutritionally intact on oral intake alone. Upper gastrointestinal series demonstrated patency of the jejunojejunostomy with anterograde flow through both limbs as well as reflux into the proximal atretic ileum. Resection of pancreatobiliary malignancy following bariatric surgery can be challenging due to restricted reconstruction options. This is particularly true after JIB where most of the functional jejunum is not suitable for an anastomosis. To our knowledge, this is the first description of a successful pancreaticoduodenectomy in a patient with an intact JIB." @default.
- W2953371843 created "2019-06-27" @default.
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- W2953371843 date "2019-03-01" @default.
- W2953371843 modified "2023-09-27" @default.
- W2953371843 title "Pancreaticoduodenectomy in a patient with jejunoileal bypass" @default.
- W2953371843 doi "https://doi.org/10.1016/j.hpb.2019.03.200" @default.
- W2953371843 hasPublicationYear "2019" @default.
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