Adipositaschirurgie

The

incremental value of multislice CT in diagnosis of late bariatric surgery complications. Gastric pouch dilatation after sleeve gastrectomy. 3D volume rendered image (a) optimally demonstrates the intact stapling line with significantly dilated gastric pouch that measures about 239 ml at CT gastric volumetry image (b). MIP image (c) resembles the traditional barium study and demonstrates anatomical changes including the radiodense intact stapling line as well as pouch dilatation

The

incremental value of multislice CT in diagnosis of late bariatric surgery complications. Gastric pouch dilatation after butterfly gastroplasty with recurrent weight gain. CT gastric volumetry image (a) clearly delineate gastric pouch (blue color) with its volume measuring 76 ml. 3D volume rendered image (b) and MIP reconstruction (c) demonstrates the anatomical changes including intact stapling line and widely patent connecting channel (stoma)

The

incremental value of multislice CT in diagnosis of late bariatric surgery complications. Hiatus hernia complicating butterfly gastroplasty with symptomatic GERD. Semitransparent 3D volume rendered image (a) accurately depicts the anatomical changes including intact stapling line with sizeable hiatal hernia containing the whole gastric pouch. The herniated gastric pouch is dilated as well, its volume = 107 ml (b). Coronal reformatted image (c) clearly demonstrates the herniated gastric pouch into posterior mediastinum well extending above diaphragm through widened esophageal hiatus

The

incremental value of multislice CT in diagnosis of late bariatric surgery complications. Vertical banded gastroplasty complicated with pouch dilatation and stenosis of the connecting stoma. 3D volume rendered image (a) demonstrates the anatomical changes including intact vertical stapling line with pouch dilatation and tight band around stoma exerting stenosis. Pouch dilatation is evident in gastric volumetry image (b) coded with blue color, its volume = 76.7 ml. MIP image (c) demonstrates intact radiodense vertical stapling line, narrowed stoma with filling defects within the dilated pouch mostly representing retained food particles. Normal appearing gastric stoma from another with the same procedure is demonstrated in (d) for comparison

The

incremental value of multislice CT in diagnosis of late bariatric surgery complications. Vertical banded gastroplasty complicated with narrowed stoma. Axial CT image reveals the significant narrowing of gastric stoma (solid arrow) connecting gastric pouch (*) with remaining stomach (open arrow). Food particles are retained within gastric pouch denoting significant stenosis of the stoma. Part of the radiodense stapling material is noted as well. Axial oblique reformatted image (b) through the anatomical plane of the stoma accurately demonstrates the significant stenosis

The

incremental value of multislice CT in diagnosis of late bariatric surgery complications. Gastric plication is complicated with gastric herniation through plication sutures. Sizeable part of gastric body is seen herniating laterally through a plication suture line at the proximal part of greater curvature. Such abnormality is well depicted at 3D volume rendered image (a) and MIP image (b). The volume of the herniated part (155.7 ml) could be measured using CT gastric volumetry (c). The remaining gastric pouch is significantly dilated as well (d), its volume = 342 ml. Retained food particles was demonstrated within the herniated part of the stomach on reviewing axial dataset (not shown)

The

incremental value of multislice CT in diagnosis of late bariatric surgery complications. Gastric pouch stricture complicating mini-gastric bypass. Coronal MIP image (a) reveals the different post-operative anatomical changes including intact radiodense stapling line, patent gastrojejunostomy site, patent both afferent and efferent jejunal loops with significant concentric narrowing at gastric pouch. Free passage of oral contrast is noted as well into jejunal loops distally. Axial CT image (b) clearly demonstrates the severe concentric stenosis at gastric pouch. Patient was complaining of persistent vomiting and endoscopic dilatation with planned thereafter based upon CT result