Duodenal Loop Obstruction as an Unusual Cause of Acute Pancreatitis: A Case Series

Hyeonmin Lee; Yonghyeok Choi; Hyewon Jeong; Jae Kyu Lim; Taeyoung Jung; Joung-Ho Han; Seon Mee Park

doi:10.4166/kjg.2016.68.6.326

Journal List > Korean J Gastroenterol > v.68(6) > 1007593

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Lee, Choi, Jeong, Lim, Jung, Han, and Park: Duodenal Loop Obstruction as an Unusual Cause of Acute Pancreatitis: A Case Series

Case Report

Korean J Gastroenterol 2016;68(6):326-330.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.6.326

Duodenal Loop Obstruction as an Unusual Cause of Acute Pancreatitis: A Case Series

Hyeonmin Lee, Yonghyeok Choi, Hyewon Jeong, Jae Kyu Lim, Taeyoung Jung, Joung-Ho Han, Seon Mee Park

Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea

Correspondence to: Seon Mee Park, Department of Internal Medicine, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, Korea. Tel: +82-43-269-6019, Fax: +82-43-273-3252, E-mail: smpark@chungbuk.ac.kr

Received 4 July 2016 Revised 27 September 2016 Accepted 4 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Duodenal loop obstruction is an unusual cause of acute pancreatitis. Increased intraluminal pressure hinders pancreatic flow, causing dilatation of the pancreatic duct and inducing acute pancreatitis. We experienced three cases of acute pancreatitis that resulted from duodenal loop obstruction after (1) an esophagectomy with gastric pull-up procedure for esophageal cancer, (2) a gastrectomy with Billroth I reconstruction for gastric cancer, and (3) a gastrojejunostomy for abdominal trauma. An abdominal CT scan revealed a distended duodenal loop, dilated pancreatic duct, and inflamed pancreas with fluid collection. Acute pancreatitis with duodenal loop obstruction was diagnosed by abdominal pain, elevated serum amylase/lipase, and abdominal CT findings. Immediate decompression with a nasogastric tube was performed, and all patients showed improvement within one week after admission. Each patient was followed up for more than two years without recurrence. Our findings suggest the usefulness of nasogastric tube decompression as the first line of treatment for acute pancreatitis related to duodenal loop obstruction.

Keywords: Pancreatitis, acute, Duodenal obstruction, Decompression

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Fig. 1.

Plain abdomen and abdominal CT images of Case 1. (A) Suspicious distended stomach filled with fluid (asterisk) without abnormal bowel gas. (B) Axial view. Dilatation of the duodenum (asterisk) and diffuse small bowel wall thickening (arrow). (C) Coronal view. Distended duodenal loop (arrow) and mild pancreatic duct dilation (arrowhead).

Fig. 2.

Plain abdomen and abdominal CT images of Case 2. (A) Suspicious distended stomach filled with fluid (asterisk) without abnormal bowel gas. (B) Axial view. A massive duodenal dilatation with a large volume of food inside (arrow). (C) Coronal view. Dilatation of the stomach (asterisk) and duodenal loop with abrupt luminal narrowing of the proximal jejunum (arrowhead). Swelling of the pancreas with peripancreatic fluid collection (arrow) is suggestive of acute pancreatitis.

Fig. 3.

Plain abdomen and abdominal CT images of Case 3. (A) Linear air at right upper quadrant area (arrow), suspicious fluid-filled stomach (asterisks), and gaseous distended colonic loop and small bowels at right sided abdomen (arrowheads). (B, C) Axial views. Marked dilation of the stomach and duodenum (asterisks) and dilation of the pancreatic duct (arrow) with fluid collection (arrowhead). (D) Coronal view. A distended duodenal loop with abrupt luminal narrowing of the proximal jejunum (arrow) and fluid collection at the pancreatic tail (arrowhead). Plain abdominal film was revealed.

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