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Narrowing of the Proximal Jejunal Limbs at Their Passage Through the Transverse Mesocolon: A Potential Pitfall of Laparoscopic Roux-en-Y Gastric Bypass

¹ Department of Radiology, The Albert Einstein College of Medicine of the Montefiore Medical Center, J. D. Weiler Hospital, 1825 Eastchester Rd., Bronx, NY 10461.
² Department of Surgery, The Albert Einstein College of Medicine of the Montefiore Medical Center, Bronx, NY 10461.

View larger version (112K): [in a new window]   Fig. 1A. —Radiographs from gastrointestinal series with water-soluble Gastrografin ([diatrizoate meglumine and diatrizoate sodium solution USP] 120 mL, Bracco Diagnostics) obtained in 62-year-old woman 1 day after laparoscopic Roux-en-Y gastric bypass. Persistent circumferential nonobstructive narrowing (arrow) at proximal Roux-en-Y jejunal loop corresponds to site of passage through transverse mesocolon.

View larger version (148K): [in a new window]   Fig. 1B. —Radiographs from gastrointestinal series with water-soluble Gastrografin ([diatrizoate meglumine and diatrizoate sodium solution USP] 120 mL, Bracco Diagnostics) obtained in 62-year-old woman 1 day after laparoscopic Roux-en-Y gastric bypass. Persistent narrowing point (arrow), with intact mucosa, corresponds to suturing of transverse mesocolon to jejunal serosa. Solid arrowhead indicates gastric pouch; open arrowhead indicates gastric pouch–jejunum anastomosis.

View larger version (138K): [in a new window]   Fig. 2A. —Radiographs from gastrointestinal series with water-soluble Gastrografin ([diatrizoate meglumine and diatrizoate sodium solution USP] 120 mL, Bracco Diagnostics) obtained in 42-year-old woman 14 days after laparoscopic Roux-en-Y gastric bypass. Nonobstructive circumferential narrowing of proximal limb of Roux-en-Y jejunal loop (arrows) is observed at site of created transverse mesocolon opening.

View larger version (142K): [in a new window]   Fig. 2B. —Radiographs from gastrointestinal series with water-soluble Gastrografin ([diatrizoate meglumine and diatrizoate sodium solution USP] 120 mL, Bracco Diagnostics) obtained in 42-year-old woman 14 days after laparoscopic Roux-en-Y gastric bypass. Persistent narrowing (arrows) is seen.

View larger version (103K): [in a new window]   Fig. 3A. —Radiographs from gastrointestinal series with water-soluble Gastrografin ([diatrizoate meglumine and diatrizoate sodium solution USP] 120 mL, Bracco Diagnostics) obtained in 34-year-old woman 1 day after laparoscopic Roux-en-Y gastric bypass. Some dilatation is seen in Roux-en-Y upper jejunal limb proximal to circumferential narrowing (arrow) at created hiatus in transverse mesocolon.

View larger version (102K): [in a new window]   Fig. 3B. —Radiographs from gastrointestinal series with water-soluble Gastrografin ([diatrizoate meglumine and diatrizoate sodium solution USP] 120 mL, Bracco Diagnostics) obtained in 34-year-old woman 1 day after laparoscopic Roux-en-Y gastric bypass. Persistence of narrowing is noted at same point (arrow) as in A.

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