D

Figure 3.12. Marginal ulcers. (A-C) Three different patients with marginal ulcers in the jejunum adjacent to the gastrojejunal anastomosis. (D) Double-contrast UGI series showing multiple marginal ulcers in the jejunum. (E) Double-contrast UGI series revealing multiple ulcers in the gastric remnant.

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 [18]. 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 [12].

Figure 3.13. Bancroft procedure. Right anterior oblique view from an upper GI series shows contrast medium extending beyond the duodenal bulb into the distal antrum, simulating retained gastric antrum. The antral mucosa was stripped at the time of surgery.

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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