MR cholangiopancreatography (MRCP) in diagnosis of afferent loop syndrome presenting as cholangitis

Magnetic resonance cholangiopancreatography is a noninvasive imaging modality that capitalizes on the ingenuity of magnetic resonance imaging to visualize static fluid-filled structures such as biliary and pancreatic ducts. A case of afferent loop syndrome presenting as cholangitis was diagnosed using this imaging technique and is described. A 71-year-old white female, with a history of pancreaticoduodenectomy 35 years ago, developed pain in the right upper quadrant of the abdomen, nausea, and vomiting, which relieved the symptoms. She later developed spiking fever and rigors. Physical examination was remarkable for right upper quadrant tenderness. Magnetic resonance cholangiopancreatography using heavily T-2 weighted images with fat suppression demonstrated a dilated atonic afferent limb of jejunum. This finding was confirmed preoperatively by percutaneous transhepatic cholangiography. A side-to-side jejunojejunostomy was performed, providing effective decompression of the dilated afferent limb of jejunum. This imaging modality promises to be a useful device in diagnosing afferent loop syndrome.