Figure 3.14. (Continued)

Gastric Stump Carcinoma

There is an increased incidence of carcinoma developing in the gastric remnant after the Billroth I and procedures II and after gastroenterostomy for benign disease [19,20]. The average interval for carcinoma to develop is about 20 years after surgery. The incidence is higher in patients who have undergone surgery for gastric ulcer than for duodenal ulcer [20]. The radiographic findings of carcinoma in the gastric remnant are similar to those in the unoperated stomach, including polypoid mass, diffuse infiltration, enlarged folds, and gastric outlet obstruction (Figs. 3.15-3.18). The tumor tends to occur at or near the anastomotic site. Errors in diagnosis may result from suboptimal technique and/or interpretive mistakes, such as attributing pathology to postoperative change. The value of having a baseline study for comparison is particularly apparent in this setting. Suture granulomas due to a foreign body reaction, which can develop after gastric surgery with nonabsorbable suture material, can be misinterpreted as neoplasm [21].

Figure 3.15. Gastric stump carcinoma. Plain film of the abdomen showing an abnormal gastric air bubble due to gastric carcinoma developing many years after Billroth II surgery for benign disease.

Figure 3.16. Gastric stump carcinoma.

Double-contrast upper GI series showing a small polypoid lesion in the gastric remnant adjacent to the anastomosis due to carcinoma.

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