case_images: PMC7395522_01
case_images: A 40-year-old male presented with jaundice, dark urine, pruritus, and a 20 lb unintended weight loss. Initial CT abdomen with IV contrast, coronal image demonstrates a hypo-attenuating pancreatic head mass measuring 2.7 cm (red arrow). There is resultant obstructive pancreatic (yellow arrow) and biliary ductal dilation (blue arrow).
case_images: JCIS-10-43-g001.jpg
case_images: PMC7395522_01_JCIS-10-43-g001.jpg
case_images: F1
case_images: A CT abdomen/pelvis demonstrated a 2.7 cm pancreatic head mass with biliary and pancreatic ductal dilation [Figure 1]. An endoscopic ultrasound with fine-needle aspiration yielded moderately-differentiated adenocarcinoma with mucinous features.
case_images: A 40-year-old male presented with jaundice, dark urine, pruritus, and a 20 lb unintended weight loss. The patient underwent a Whipple procedure for pancreatic cancer, recovered well, and presented 6 weeks later with moderate-severe pain, nausea, vomiting, and repetitive dry heaving. (a and b) Axial CT images with IV and oral contrast demonstrate dilation of the afferent loop (red arrow). Free intra-abdominal fluid is present (yellow arrow). There is twisting of the mesentery with poor opacification of the superior mesenteric vein (blue arrow) (c) Coronal CT image demonstrate dilation of the afferent loop (red arrow). Free fluid is again demonstrated (yellow arrow). The distal small bowel is normal. The gastrojejunostomy site is visualized (green arrow). (d) Sagittal CT image with IV and oral contrast demonstrates a transition point within the afferent loop distally (purple arrows). Dilation of the more proximal afferent loop is again seen (red arrow). Free fluid is present (yellow arrows).
case_images: JCIS-10-43-g002.jpg
case_images: PMC7395522_01_JCIS-10-43-g002.jpg
case_images: F2
case_images: A STAT CT abdomen/pelvis demonstrated post-Whipple anatomy, but with distension of the afferent pancreaticobiliary limb, measuring up to 4.7 cm [Figure 2].
case_images: A 40-year-old male presented with jaundice, dark urine, pruritus, and a 20 lb unintended weight loss. The patient underwent a Whipple procedure for pancreatic cancer, recovered well, and presented 6 weeks later with moderato-severe pain, nausea, vomiting, and repetitive dry heaving. After CT findings compatible with afferent loop syndrome, the patient underwent exploratory laparotomy. Intraoperative gross image demonstrates dilated, dusky, ischemic-appearing bowel (white arrows). This correlates with the CT findings and represented the afferent loop. An adjacent efferent loop (blue arrow) was normal in caliber.
case_images: JCIS-10-43-g003.jpg
case_images: PMC7395522_01_JCIS-10-43-g003.jpg
case_images: F3
case_images: Exploration revealed a segment of dilated dusky small bowel [Figure 3] corresponding to the afferent pancreaticobiliary limb.