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Fig. 5 —Schematic shows connected Roux-en-O misconstruction. Biliary limb is anastomosed to gastric pouch instead of to distal end of Roux-en-Y limb. Proximal end of Roux-en-Y alimentary limb is anastomosed to biliary limb instead of to gastric pouch. Features may look anatomically correct on static images, but peristalsis in Roux limb connected to gastric pouch is reversed (thin arrows), causing functional obstructive symptoms.