Postoperative anatomic and pathologic findings at CT following gastrectomy

Helical computed tomography (CT) is useful in identifying postoperative anatomic changes, complications, and tumor recurrence in gastric cancer patients who have undergone gastrectomy. Postoperative anatomic changes can usually be identified on consecutive CT scans. Complications include anastomotic leakage, duodenal stump leakage, intraabdominal bleeding, wound complications, and other less common complications (postoperative pancreatitis, retention of surgical foreign bodies, diffuse peritonitis). The degree and extent of bowel wall thickening is important in diagnosing tumor recurrence; however, CT lacks specificity. Large or conglomerated lymph node metastases can be easily diagnosed at CT; however, small solitary or focal metastases may not be detected or differentiated from nonmetastatic nodes. Ascites, a common finding with peritoneal seeding in gastrointestinal tumors, is well depicted at CT. Hematogenous metastases from gastric carcinoma are most frequently seen in the liver and are best demonstrated with helical CT performed during the portal venous phase of enhancement (sensitivity >90% for the detection of lesions >1 cm). The sophisticated surgical procedures used in gastrectomy can alter normal anatomy and make image interpretation difficult; thus, familiarity with the appearance of postoperative anatomic changes, complications, and tumor recurrence is essential for accurate CT evaluation of affected patients.