dure may be performed when resection of the antrum is technically difficult. Retained gastric antrum can also be diagnosed by nuclear scintigraphy using pertechnetate scanning . The method used is the same as that used in the search for ectopic gastric mucosa in Meckel's diverticulum. Radioactive technetium-99m (99mTc) is handled in a biologically similar fashion to halogens and is excreted by normal gastric mucosa.
Now that simple gastroenterostomy has been abandoned as a primary operation for peptic disease and vagotomy has become routine, the complication of gastrojejunocolic fistula in marginal ulcers has declined in incidence (Fig. 3.14). In patients with a retrocolic anastomosis, the incidence of gastrojejuncolic fistula is increased. Barium enema has been shown to be the most reliable examination in making this diagnosis .
Figure 3.14. Gastrojejunocolic fistula secondary to marginal ulcer after Billroth II. (A)
Upper GI series showing filling of the stomach, jejunum, and colon due to fistula formation from a marginal ulcer. (B) Barium enema demonstrating the same. (C) Upper GI series in another patient demonstrating a marginal ulcer and gastrojejunocolic fistula.
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