Post-Gastrectomy Complications

Rupture of the Duodenal Stump

• Incidence <5%

• Grave complication–death in half the cases

• Occurs without warning from post-op day 1-21

• Probably related to ischemia at anastomotic line

• Usually results in subdiaphragmatic collections

• Use of iodinated contrast (Gastrografin) preferred

Hemorrhage

• From 3-12% incidence

Obstruction

• Stomal obstructions are caused by edema or hemorrhage usually

• May be the result of vagotomy without pyloroplasty

• Gastric bezoars may form in post-op stomach and obstruct

• Intussusception may be either antegrade or retrograde

• If retrograde, the jejunum invaginates into the gastric pouch

• A striated filling defect is seen in stomach which is pathognomonic

• If antegrade, almost always into efferent loop

Marginal Ulcer Disease

• New ulcerations which occur in the jejunum no more than 2cm distal to anastomosis

• Usually in efferent loop

• Radiographic diagnosis of ulcer itself is possible in only about 50% of cases but some sign may be seen in as many as 80%

• Double-contrast exams are the study of choice

• X-ray includes

1) Dilatation of the jejunum

2) Thickened folds in jejunum

3) Ulcer crater

Ulcerogenic tumors (i.e. gastrinomas)

• Multiple recurrent ulcers, ulcers in unusual places should alert to retained antrum or ulcerogenic tumor

Carcinoma of the gastric stump

•Post-gastrectomy for gastric ulcer has a lower incidence of ca than does post-gastrectomy for duodenal ulcer disease

WH/93