PMC9035941_01
CT on admission (a: axial, b: coronal) showed a dilated afferent loop and a low-density lesion in the peritoneum causing mechanical obstruction.
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F1
An abdominal computed tomography (CT) scan showed a dilated afferent loop and a low-density lesion in the peritoneum that suggested recurrence of the hilar biliary adenocarcinoma and malignant ALS due to mechanical obstruction of the afferent loop caused by peritoneal dissemination (Fig. 1).
a, b EUS-guided plastic stent placement was successful. After the procedure, the CT scan (c) showed improvement of the dilation of the afferent loop.
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F2
Finally, we inserted a double pig-tail plastic stent (7Fr.-7cm double pig-tail stent, Zimmon type; COOK, Winston Salem, NC, USA) (Fig. 2a, b). The dilated afferent loop immediately began shrinking on CT after the procedure (Fig. 2c).
Reintervention for recurrence of ALS was successful. Two plastic stents were inserted from the stomach through the fistula.
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F3
Finally, over the 0.035-inch guidewire, we deployed the second double pig-tail stent, a 7Fr.-4cm Zimmon, into the remained gap in the fistula (Fig. 3).