Although most patients will not develop sequelae after surgery, there are unfortunately a large number of early and late postoperative complications that may ensue (Table 3.2).
In the early postoperative period after Billroth surgery, anastomotic leaks may develop. Leaks are generally readily detected by water-soluble contrast administration or CT imaging. Subsequent subphrenic abscesses, usually left sided, may ensue. Leaks are the most common cause of mortality after gastric surgery .
Rupture of the duodenal stump ("duodenal stump blowout") after Billroth II is one of the most serious complications of gastric surgery. This may occur as early as the first or as late as the nineteenth postoperative day, although it is usually identified between the third to seventh postoperative day . Contrast examination may be diagnostic, although complete filling of the A limb is necessary for diagnosis, and this may be difficult to achieve (Fig. 3.7). CT imaging may reveal extraluminal contrast, collections, and/or abscess adjacent to the duodenal stump or in the right subphrenic space (Fig. 3.8).
Table 3.2. Complications of gastroduodenal surgery.
Duodenal stump blowout Anastomotic leak
Anastomotic edema and gastric outlet obstruction Intussusception (antegrade or retrograde) Gastroileostomy Late
Obstruction secondary to anastomotic stricture
Bezoars (food or yeast)
Intussusception (antegrade or retrograde)
Recurrent (marginal) ulcer
Gastric stump carcinoma
Afferent limb syndromes (acute or chronic) Alkaline reflux gastritis Postgastroenterostomy contraction of gastric antrum Efferent loop dysfunction Fistula
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