| Summary: | A 56-year-old male underwent a Whipple procedure for duodenal stricture secondary to a 32-mm duodenal adenocarcinoma. The patient presented again 66 months later with obstructive jaundice caused by an obstruction in the afferent loop. Biliary drainage was performed to relieve the obstruction. Two attempts to cross the occlusion were performed, but these were both unsuccessful. Percutaneous transhepatic stent deployment through the obstruction has previously been described in similar cases but was not feasible in this case. An attempt at retrograde cannulation was performed from a direct puncture of the bowel but this failed. Rather than abandoning the case, an extra-anatomic approach was taken by passing a needle across the point of malignant obstruction forming a new track between the Roux loop and small bowel, enabling a covered stent to be placed and relieving the biliary obstruction. This avoided the need for permanent external biliary drainage and its associated complications. Extra-anatomic percutaneous stenting is a viable alternative for the treatment of malignant afferent loop obstruction following pancreaticoduodenectomy. © 2022, Society of Gastrointestinal Intervention.
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