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NewYork-Presbyterian Hospital Psychiatry
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Case of the Month 02/2017

This patient with history of gastric ca s/p total gastrectomy and roux-en-y and esophageal ca s/p jejunostomy tube presented to the ED complaining of abdominal pain and resistance with flushing her J tube.

Question 1 : What’s wrong with these pictures?

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View answer
Answer 1:

There is marked dilation of the bowel (arrows below) and the gallbladder (star below.)



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Question 2: If you were told that the arrows below pointed to an obstruction in the afferent limb of the Roux-en-Y, could you explain the gallbladder dilation?

radiology-image-1

View answer
Answer 2:

The afferent loop is the part of the duodenum which remains attached to the pancreas and biliary system (arrow below) allowing for drainage into the GI tract. This patient had an obstruction of that afferent loop causing biliary obstruction in dilatation.



radiology-image-1
https://www.halstedsurgery.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_ID=AF793A59-B736-42CB-9E1F-E79D2B9FC358&GDL_Disease_ID=DB2F8EAC-4421-41DD-B04E-684AFEF2AD94



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