Imaging of postgastrectomy complications in gastric cancer
Póster Nº:17SEDIAPOS0121
Tipo:Electrónica Educativa
Autores: Atenea Morcillo Cabrera, Said Fettane Gómez
Keywords:gastric cancer, postgastrectomy complications, reconstruction techniques
SECCIONES
Objetivo docente

CT plays a key role in preoperative staging of gastric cancer and evaluation of postoperative complications. There is an extensive literature about the radiologic findings in bariatric surgery but there are just a few reports about CT abnormal appearances after radical gastrectomy.

The oncologic patient is always subject to many imaging tests to control the disease. For that reason the radiologist should be familiar with the different surgical techniques in order to recognize the anatomic changes.

The surgery of gastric cancer has a high morbimortality with a complication rate of 14-43% and 0,8-12% in mortality (1). Therefore it is fundamental to keep in mind the most common complications after a gastrectomy and learn the radiological signs to detect them easily in an emergency setting.


Revisión del tema

Anatomical changes

The surgical treatment is individualized depending on the extent of resection. The surgical procedures include:

1) Total gastrectomy, most of them are reconstructed with Roux-en-Y esophagojejunostomy (EJS) and in the 17,5% of the cases, they are completed with splenectomy and the 7,1% with partial pancreatectomy (1).

2) Partial gastrectomy preserves the gastric fundus and gastrointestinal continuity can be restored using one of three techniques:  Billroth I, Billroth II and Roux-en-Y gastrojejunostomy (GJS) (Figure 1).

The Billroth I reconstruction consists of an end-to-end gastroduodenal anastomosis. The most common postgastrectomy syndrome associated with Billroth I is biliary reflux into stomach causing alkaline...

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Figure 1. GI reconstructions techniques after partial gastrectomy. Stanley W Ashley M. Postgastrectomy complications. 2017; Available at: https://www.uptodate.com/contents/postgastrectomy-complications?source=see_link. Accessed 8/2017.
Figure 2. Postgastrectomy complications of the first postoperative week. Modified table of: Figarra BJ. Postgastrectomy complications. Am J Gastroenterol 1958;30(1):77-84


Conclusiones

Conclusions

The complexity of the surgical techniques in gastric cancer makes the image interpretation difficult, even when there is no pathology and normal postoperative anatomy should be analyzed. The knowledge of the possible complications is also essential for an accurate CT evaluation in the emergency setting. The early complications most frequently assessed by CT can be summed up in two: leakage or gastrointestinal obstruction. The leakage used to take place in the anastomotic sites or the duodenal stump and the GI obstruction is caused by multiples pathologies as afferent or efferent loop syndrome, jejunal intussusception or internal hernia.

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