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. 2021 Feb 9:86:e102-e111.
doi: 10.5114/pjr.2021.104003. eCollection 2021.

Diagnostic imaging in the diagnosis of acute complications of bariatric surgery

Affiliations

Diagnostic imaging in the diagnosis of acute complications of bariatric surgery

Antonio Catelli et al. Pol J Radiol. .

Abstract

Purpose: The aim of study is to identify the frequency of acute complications and imaging findings at gastro-intestinal transit (GI) and computerised tomography (CT) in a group of obese patients who developed clinical suspicion of acute complications (painful and meteoric abdomen, nausea, vomiting, fever, intestinal blockage) in post bariatric surgery.

Material and methods: We retrospectively review 954 obese patients who underwent bariatric surgery between 2013 and 2019. The study included 72 patients who developed clinical suspicion of acute complications (painful and meteoric abdomen, nausea, vomiting, fever, intestinal blockage) within 6 days of bariatric surgery of sleeve gastrectomy, gastric banding, gastric bypass with Roux loop confirmed by CT, and who underwent a gastrointestinal transit before the CT examination.

Results: GI exam allowed visualisation of 58% of complications. Analysing the data for each surgical technique, 46 post-operative complications were found involve gastric banding. The most frequent was bandage migration (26 cases, 56 %), identified in all cases at GI transit and then confirmed on CT.

Conclusions: The study suggests that CT should be used to clarify all doubtful or clinically discordant GI transit exam results. The participation of a radiologist in qualification and post-operative evaluation is important for bariatric surgery patients.

Keywords: BMI; CT; GI transit X-ray; bariatric surgery; post-surgical complications; sleeve gastrectomy.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Gastro-intestinal transit in a patient with a gastric band. A) Thin arrow: gastric band ring; thick arrow: external reservoir. B, C) Asterisk: regular passage through the bandage of contrast medium per os
Figure 2
Figure 2
Gastric band intra-ileal migration. A) Absence of bend in the typical site. B-D) Thin arrow: the presence of the connection catheter between the reservoir and the gastric band ring is highlighted. E, F) Bandage ring migrated to the endo-luminal ileal site (thick arrow)
Figure 3
Figure 3
Gastric volvulus in a patient with gastric banding. Over-distended gastric bottom with fluid stagnation (asterisk) and gastric band ring (thin arrow). Remaining gastric portion rotated and suffering with perivisceral fluid (thick arrow) and perivisceral liquid (+)
Figure 4
Figure 4
Intestinal obstruction from a gastric band catheter. A) Scout-view: abnormal and elongated course of the bandage device catheter. B) Compression of the jejunal loop secondary to traction exerted by an adipose tissue band attracted by the catheter in an abnormal location. C, D) Over-distension of the stomach, duodenum, and fasting. E) Traction on the parietal peritoneum
Figure 5
Figure 5
Sleeve gastrectomy suture dehiscence. Extravasation of contrast medium from the proximal region of the suture, demonstrated both during the GI transit and in CT
Figure 6
Figure 6
Anastomotic dehiscence in outcome of sleeve gastrectomy with fistulised collection at the level of the anterior abdominal wall. A) Via fistula with the stomach. B-D) Route of the fistula in axial and sagittal oblique section. C) Opacification of the collection under fascial
Figure 7
Figure 7
Anastomotic suture dehiscence in sleeve gastrectomy outcomes with transdiaphragmatic fistulised lung collection. A, B) Metallic sutures in sleeve gastrectomy outcomes (white arrow), with adjacent hydro-aerial collection (arrowhead). C) Transdiaphragmatic fistula route (arrowhead) with abscess collection in the lung parenchyma
Figure 8
Figure 8
Intraperitoneal haematoma adjacent to the sleeve gastrectomy suture. A) Spontaneous hyperdense haematoma in the pre-contrast phase in the 2/3 distal of the gastric suture. B, C) In the post-contrast phases an active supply cannot be documented
Figure 9
Figure 9
Internal hernia in a patient with a gastric bypass. A) Arrow: gastric bypass results – asterisk: perihepatic liquid flap. B) Thickened peri-anastomotic fat (arrow). C) Fluid stratum in Morrison (asterisk)
Figure 10
Figure 10
Occlusion on the bridle at the entero-enteric anastomosis in a patient operated on by gastric bypass. A) Outcomes of gastric bypass surgery (arrow). B) Laparocele input. C) Laparocele output. D) Entero-enteric anastomosis loop foot housing the mechanical stop on the bridle (arrow)
Figure 11
Figure 11
Volvulus in patient operated by gastric by-pass. A) Outcomes of gastric by-pass. B) Volvulus entrance. C) Volvulus exit (arrow) and suffering loop (asterisk). D) Faecaloid stasis. E) Reconstruction on the coronal plane shows signs of venous hypertension in suffering loops with stop of the venous vessels

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