This paper reports three cases of malignant afferent loop obstruction after choledochojejunostomy. In the first case, a 75-year old woman, who had undergone left hepatectomy for bile duct cancer with bile duct resection, was admitted for Roux en Y reconstruction after choledochojejunostomy because of emesis. The local recurrent tumor caused occlusion of the duodenum and afferent limb, and bypass surgery was performed after transintestinal drainage. In the second case, a 57-year-old man, who had undergone pancreaticoduodenectomy for pancreas cancer, was hospitalized with a high-grade fever and epigastric pain. Exploratory laparotomy revealed widespread carcinomatosis causing afferent loop obstruction, and bypass surgery was performed. In the third case, a 60-year-old woman with paraaortic lymphnode recurrence of gallbladder cancer was admitted as she had afferent loop syndrome. Transintestinal drainage was performed. All these three patients were discharged. Bypass surgery for selective patients turned out to be an effective palliative treatment for malignant afferent loop obstruction.

A woman in her 80s who had difficulty walking due to back pain was admitted to our hospital. Until two months earlier, she had been able to live independently in daily life. She was not severely constipated, did not take laxatives, and had not received an enema or undergone stool extraction. She had no abdominal symptoms, such as abdominal pain or distension. Surprisingly, however, computed tomography showed lower rectal perforation with subcutaneous emphysema in the pelvic retroperitoneum, hip, and left inguinal region. Therefore, we urgently performed abdominoperineal resection to save her. The lower rectum is a relatively uncommon site of perforation in the large intestine, and nontraumatic cases are rare. Elderly patients in particular may have only atypical symptoms and thus require careful attention.