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Detection of Strictures on Upper Gastrointestinal Tract Radiographic Examinations After Laparoscopic Roux-En-Y Gastric Bypass Surgery: Importance of Projection

Saurabh Jha1, Marc S. Levine1, Stephen E. Rubesin1, Kristoffel Dumon2, Michael L. Kochman3, Igor Laufer1 and Noel N. Williams2

1 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
2 Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104.
3 Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104.


Figure 1
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  		Fig. 1A —34-year-old woman with nausea and vomiting after gastric bypass surgery. Patient has tight anastomotic stricture only seen on steep oblique views because of its anterior location. Frontal spot view from single-contrast upper gastrointestinal study shows barium in gastric pouch (small black arrow), proximal jejunum (large black arrow), and blind-ending jejunal stump (white arrow) secondary to Roux-en-Y reconstruction. No stricture is seen at gastrojejunal anastomosis, but overlap between lower end of gastric pouch and proximal jejunum obscures this region.

 

Figure 2
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  		Fig. 1B —34-year-old woman with nausea and vomiting after gastric bypass surgery. Patient has tight anastomotic stricture only seen on steep oblique views because of its anterior location. Steep right posterior oblique view from same study shows anteriorly located anastomotic stricture in profile (small black arrow). Also note barium in gastric pouch (small white arrow), proximal jejunum (large black arrow), and blind-ending jejunal stump (large white arrow).

 

Figure 3
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  		Fig. 2A —36-year-old woman with dysphagia after gastric bypass surgery. Patient has anteriorly located anastomotic stricture only seen on steep oblique views. Frontal spot view from single-contrast upper gastrointestinal study shows barium in gastric pouch (black arrow) and proximal jejunum (white arrow). No stricture is seen at gastrojejunal anastomosis because of overlap between pouch and jejunum obscuring this region.

 

Figure 4
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  		Fig. 2B —36-year-old woman with dysphagia after gastric bypass surgery. Patient has anteriorly located anastomotic stricture only seen on steep oblique views. Steep right posterior oblique view from same study shows anteriorly located anastomotic stricture in profile (small black arrow). Also note barium in gastric pouch (white arrow) and proximal jejunum (large black arrow).

 

Figure 5
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  		Fig. 3 —29-year-old woman with epigastric pain after gastric bypass surgery. Frontal view from single-contrast upper gastrointestinal study shows inferiorly located anastomotic stricture in profile (black arrow). Because anastomosis is located on inferior wall of gastric pouch (large white arrow), this stricture is clearly visible on frontal image. Small white arrow = proximal jejunum.

 

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