(A) Water-soluble contrast study shows a large ulcer at the anastomotic site after GBP. (B) Another patient with a perforated ulcer arising
(A) Water-soluble contrast study shows a large ulcer at the anastomotic site after GBP. (B) Another patient with a perforated ulcer arising from the gastric remnant. (C) Staple line dehiscence and an ulcer on the lesser curvature of the stomach after GBP.
be identified in patients with perforated ulcers in the distal stomach, making the diagnosis more difficult.
Obstruction of the distal stomach may occur after GBP or gastroplasty, and obstruction of the afferent limb may occur after GBP. In the early postoperative period, if a gastrostomy is in place, evaluation of the distal stomach is easily performed by injecting contrast medium into the gastrostomy tube. In the late postoperative period or if a gastros-tomy is not present, CT imaging is the examination of choice, since following GBP, the distal stomach and afferent limb will not be visualized with a routine oral contrast examination, especially if a Roux-en-Y anastomosis is employed. Dilatation of the excluded stomach may be due to gastric atony, edema, or preferential filling of the afferent limb. CT imaging readily demonstrates a dilated stomach and/or A limb, although weight limitations of the scanner and/or size limitations of the gantry may render the use of this equipment unfeasible. A dilated excluded stomach could be confused with an abscess, and alternatively an abscess might be mistaken for a distended stomach. Rarely, perforation of the excluded distal stomach may occur secondary to severe dilatation or ulcer (Fig. 3.77).
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