Intrahepatic Ductal Rupture and Ectasia

Intrahepatic ductal rupture is a complication that occurs secondary to intraoperative extraction of biliary calculi with Fogarty balloon catheters 55 . With this technique, the catheter is often advanced blindly into the intrahepatic ducts through a choledochotomy. The balloon is inflated and then withdrawn to remove calculi. Intrahepatic ducts may rupture if the balloon is distended beyond the luminal capacity of the duct. The use of fluoroscopy would help to prevent this Figure 4.32....

Gastroenterostomy

A gastroenterostomy, usually gastrojejunostomy, may be performed as a drainage procedure with vagotomy for peptic ulcer disease and in patients with unresectable antral carcinomas and other conditions that may lead to antral narrowing, such as Crohn's disease. In the past, simple gastroenterostomy was a commonly performed procedure for PUD, although it was abandoned owing to the high ulcer recurrence rate. An anastomosis is generally made between the jejunum and the greater curvature of the...

Adhesions

In discussing small-bowel obstruction, one must take into account that adhesions are either the first 1,2 or second 3 most common cause. One study states that up to 70 of small-bowel obstructions in the United States are secondary to adhesions 4 , while other studies showed that the rate may vary between 49 5,6 and 80 7 . A prospective study showed that at surgery, 93 of patients with prior abdominal surgery had evidence of adhesions even if they were not obstructed 8 . In patients with...

Fundoplication

Stricture Upper Series

The causation of lower esophageal sphincter incompetence that can lead to gastroesophageal reflux is multifactorial. The list may include transient lower esophageal sphincter (LES) relaxation not related to a swallow, decreased resting tone of the LES, gastric motility disturbances, and distortion of the gastroesophageal junction anatomy (lack of a flap valve mechanism) 128 . The relationship of reflux and the presence of a hiatal hernia is unclear. The surgical management of gastroesophageal...

Ileal Pouch Anal Anastomosis IPAA

The ileal pouch-anal anastomosis (IPAA) (also called ileoanal anastomosis, ileoanal reservoir, and ileoanal pull-through) is a technique originally described by Ravich and Sabiston in 1948. It was devised to remove the entire colon while maintaining intestinal continuity, avoiding a permanent ileostomy, and maintaining continence. The operation is usually performed in patients with ulcerative colitis or familial ade-nomatous polyposis syndrome (FAPS). Patients with Crohn's disease are not good...

Intraperitoneal Gallstones Dropped or Spilled Stones

With the advent of LC, spillage of gallstones into the peritoneal cavity due to perforation of the gallbladder or spillage during removal of the gallbladder itself has become a recognized complication of cholecys- tectomy, one rarely seen with open cholecystectomy. Initial opinion was that stones left in the peritoneal cavity were harmless. However it is now accepted that there are potential complications from dropped stones, including abscess, sinus tracts, septicemia, and adhesions....

References

Pneumoperitoneum associated with artificial ventilation. BMJ 1979 1(6177) 1528-1530. 2. Cancarini GC, Carli O, Cristinelli MR, Manili L, Maiorca R. Pneumoperitoneum in peritoneal dialysis patients. J Nephrol 1999 12 95-99. 3. Bryant L, Wiot J, Kloecker R. A study of the factors affecting the incidence and duration of postoperative pneumoperitoneum. Surg Gynecol Obstet 1963 117 145-150. 4. Bevan PG. Incidence of postoperative pneumoperitoneum and its significance. BMJ 1961 2 605-609....

Gvr

Finney Strictureplasty

Crohn's disease with two different strictureplasties. (A) Single supine film from a double-contrast enteroclysis of a patient with Crohn's disease and multiple operations in the past for obstruction. In the left lower quadrant, a small deformity is seen secondary to a prior Heineke-Mikulicz procedure. In the upper abdomen a larger, almost saccular appearance is noted secondary to a prior Finney strictureplasty. (B) Spot film of the Heineke-Mikulicz strictureplasty showing saccular...

Terminology and Normal Appearances Billroth I and Billroth II

Heineke Mikulicz Pyloroplasty

To perform a technically adequate study and to obtain all the pertinent information required, the radiologist must be familiar with the many types of gastric surgical procedure that may be performed. There are multiple eponyms and descriptive terminology used in gastric surgery. Billroth I is loosely used to refer to any partial gastric resection with an anastomosis to the duodenal stump (Fig. 3.1). Billroth II loosely refers to any partial gastric resection with a gastrojejunostomy the duo-...

Gastrostomy

One of the oldest gastric operations, gastrostomy was first performed in 1876. It is also one of the most commonly performed procedures, usually done for feeding purposes and less commonly for gastric decompression. A Foley, Pezzer, Malecot, or straight Robinson catheter may be employed. The most often used method now is percutaneous endoscopic gastrostomy (PEG), although a percutaneous procedure with fluoroscopic guidance also may be performed 46-49 . In the endoscopic technique, first...

Incisional Hernia In Midline Pelvic

Abscess secondary to retained lap pad. Two CT sections reveal a large perihepatic abscess (A) secondary to a retained lap pad (B). Figure 1.33. Abscess secondary to retained lap pad. Two CT sections reveal a large perihepatic abscess (A) secondary to a retained lap pad (B). ular retained mass presents as multiple polypoidal defects in the bowel lumen as barium insinuates itself into the sponge matrix 78 . Sonography may also detect gossypibomas, either as an incidental finding or...

Complications of Obesity Surgery

Slipped Gastric Band Upper

Various complications may develop after bariatric surgery (Table 3.5). Table 3.5. Postoperative complications of gastric restrictive surgery. Gastric perforation Staple line dehiscence Channel obstruction Distal gastric or afferent limb obstruction Late Staple line dehiscence Channel widening Channel stenosis Distal gastric and afferent limb obstruction Pouch dilatation Gastric or jejunal ulcer Small bowel obstruction internal hernia Adhesions Leakage may occur from any stapled or sutured...

Bariatric Surgery

The use of surgical procedures to control morbid obesity, a condition that affects more than 5 million Americans 114 , has been around for a long time. Currently, interest is focused on the stomach and various procedures to control its capacity and absorptive ability. Previously, a not uncommon procedure was jejunoileal bypass 115 . This was introduced in 1963 but is no longer performed. However, it is possible that one will be called upon to examine the abdomen and GI tract of an individual...

Cholecystectomy

Cholecystectomy is the most commonly performed general surgical procedure in the United States. Approximately 600,000 cholecystec-tomies are performed each year, and the number has been increasing with the advent of laparoscopic cholecystectomy. Indications for cholecystectomy include acute and chronic calculous and acalculous cholecystitis, symptomatic gallstones, gallstone pancreatitis, gallbladder polyps, porcelain gallbladder, gallstones in patients with sickle cell disease, and large...

Complications of Colonic Resection

Leakage at the anastomotic site is the most common complication of colonic resection in the early postoperative period, and the cause of the highest morbidity and mortality. The rate of leakage is highest with low anterior resection, with clinically significant leaks reported in 5 to 10 of cases. A mortality rate of up to 50 may be expected if a leak is not promptly recognized 22 . Leaks usually develop 1 to 2 weeks after surgery but may be clinically silent and not apparent until up to months...

Wlk

Mineral oil globulosis. (A) Supine film of the abdomen of another patient reveals large masses with cyst wall calcifications in the upper abdomen. (B) CT scan on the same patient shows the thick calcified wall encompassing a mixed attenuation center. (C) Magnified view on one of these lesions demonstrates some of the low density lipid material within the pseudocyst. (Courtesy of S.R. Baker, MD, Newark, NJ) confusion among radiologists themselves, let alone between radiologists and...

The General Abdomen

Feeding Tube Small Intestine

Free intraperitoneal air is expected in the immediate postoperative period. The frequency and duration of its detection may vary with the diagnostic modality utilized. The clinical importance of its detection may depend on whether the patient is receiving mechanical ventilation. Free intraperitoneal air may result from the dissection of air from a ruptured alveolus, back along the tracheobronchial tree, through the mediastinum, and either transdiaphragmatic or via the retro-and subperitoneum...

Radiology of the Stomach After Surgery for Obesity

Morbid obesity is a common problem associated with serious medical complications. Various operative procedures have evolved due to poor success in achieving permanent weight loss in these patients with dietary and behavioral therapy. The number and variety of procedures that have been used reflect the creativity and ingenuity of their developers and attest to the variety of problems and complications associated with each of type of operation. The rationale behind the surgical approach to...

B

Incarcerated Cantor tube. A Supine film of the abdomen A showing a Cantor tube in the distal small bowel. Attempts at withdrawing the tube were unsuccessful, so the tube was cut loose and allowed to pass distally B . Percutaneous puncture of the balloon is a relatively safe and well-tolerated option. Use of a small-gauge needle allows safe passage through the small-bowel wall without undue risk of injury and leakage of intestinal contents even in the face of obstruction 34 . CT...