Gastric bypass has been recognized as a successful surgical approach to morbid obesity. The risky procedure has a high likelihood of complications, however. While not an option in the past, CT can now help spot postoperative trouble, according to a study in the June issue of Radiology.
Dr. Jinxing Yu and colleagues at Virginia Commonwealth University performed 100 abdominal and pelvic CT examinations in 72 patients after gastric bypass surgery to treat morbid obesity. They found that CT can detect several types of postprocedural complications, including some that could be life threatening.
The researchers identified the gastric pouch in 96% of cases, excluded stomach in 100%, proximal efferent loop in 99%, oversewn jejunal loop in 88%, and distal jejunojejunal anastomosis in 67%.
Among the 62 abnormalities they detected in 41 patients were leak (12), fluid collection unrelated to leak (nine), distended excluded stomach, small-bowel obstruction, and gastric staple line dehiscence (six), splenic infarction and hematoma (five), left hepatic lobe infarction (three), and gastric bypass-related hernia (10).
Morbid obesity has become an alarming public health concern in the U.S. in recent decades, leading to surgical approaches like the gastric bypass.
The surgical modification of gastrointestinal anatomy may make it difficult to detect complications such as gastric leaks, which may evolve into life-threatening conditions like peritonitis. Spiral CT may play an important role in the diagnosis of leaks, especially when patients present with unexplained symptoms like fever, tachycardia, and abdominal pain, according to the researchers.
CT could help further by guiding interventional treatments of many of these complications. Physicians need to get acquainted with the CT appearance of both normal gastrointestinal tract and complications after bypass surgery in order to avoid misdiagnosis in this patient population, the study said.
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