Malignant Afferent Loop Obstruction with Gastric Stump Carcinoma Following Pancreaticoduodenectomy in Pancreatic Neuroendocrine Tumor: Case Report

Introduction: Obstruction of the afferent or efferent limbs of a gastrojejunal anastomosis is a potential complication after pancreaticoduodenectomy resulting in either gastric outlet obstruction or afferent limb syndrome. Although the majority of pancreatic neuroendocrine tumors are sporadic, pancreatic neuroendocrine tumors are rare and comprise only 1–2 % of all pancreatic neoplastic disease and surgery remains the cornerstone of therapy and the only curative approach.

Method: We reviewed here a patient with pancreatic neuroendocrine tumor treated with pancreaticoduodenectomy who developed recurrent disease resulting in obstruction of the afferent limb with gastric outlet obstruction and gastric stump carcinoma which is poorly known as a long-term complication after pancreaticoduodenectomy

Result: Patient developed gastric stump carcinoma and afferent loop obstruction 2 years after pancreaticoduodenectomy for carcinoid head of pancreas. During surgical exploration she was found to have a dilated afferent limb and widespread peritoneal carcinomatosis was diagnosed intra-operatively. Hence, only palliative redo-gastrojejunostomy was performed

Conclusion: Complications from recurrent pancreatic cancer can result in afferent loop obstruction. This leads to stasis of the biliary, intestinal and pancreatic secretions. Prolonged biliary reflux might be the most important risk factor of gastric stump carcinoma following pancreaticoduodenectomy. Although pancreatic neuroendocrine tumors is a rare, studies on postoperative adjuvant management must be uniform and clear to be able to interpret the results in the right way and to use the results in daily practice so it be a suitable treatment for patients with risk factors for relapse, and surveillance is still feasible management option.