PMC9387390_01
Computed tomography of abdomen and pelvis demonstrating gastroduodenal outlet obstruction secondary to unresectable pancreatic head mass (A). Arrow points to transition point (B) and pancreatic head mass (C).
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F1
His imaging was consistent with gastroduodenal outlet obstruction secondary to the pancreatic mass (Figure 1).
Widely patent afferent limb (A) which on intubation revealed the jejunal extension of the gastrojejunal tube (B). The sharply angulated efferent limb (C) was intubated, with placement of a nasojejunal tube (D, E). This angle caused a functional obstruction.
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F2
EGD (Figure 2) demonstrated a widely patient afferent limb; push enteroscopy showed the jejunal limb of the gastrojejunal tube in the proximal jejunum.
Repeat Esophagogastroduodenoscopy With Placement Of An Uncovered WallFlex  Through-the-scope Colonic Stent. Efferent Limb (A), Followed By Uncovered Stent Placement Into The Efferent Limb (B, C). Arrow (B) Demonstrates The Afferent Limb. Final Fluoroscopic Images Demonstrated Appropriate Stent Placement (D).
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F3
We then placed a through the scope uncovered WallFlex  colonic stent (25 mm x 90 mm, Boston Scientific, Natick, MA) (Figure 3).
Upper gastrointestinal study performed after uncovered stent placement demonstrated prompt contrast emptying via the stent into the efferent limb (Arrow).
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F4
A repeat UGI study (Figure 4) revealed markedly improved gastric emptying into the efferent limb through the stent.