Complications after total gastrectomy and esophagojejunostomy: radiologic evaluation

Total gastrectomy and esophagojejunostomy is an increasingly common operation that is associated with a variety of early and late postoperative complications. Between 1980 and 1990, 26 patients at our hospital who underwent this surgery (19 Roux-en-Y esophagojejunostomies and seven loop esophagojejunostomies) had postoperative upper gastrointestinal studies with water-soluble contrast material or barium. The studies were performed during the early postoperative period (within 30 days after surgery) in seven patients, the late postoperative period (more than 30 days after surgery) in seven patients, or both in 12 patients. Five patients (19%) had anastomotic leaks, four involving the esophagojejunal anastomosis and one the blind-ending jejunal limb. Five patients (19%) had transient narrowing of the esophagojejunal anastomosis during the early postoperative period, probably due to acute postoperative edema and spasm. Six patients (23%) had narrowing of the esophagojejunal anastomosis during the late postoperative period due to anastomotic strictures (three patients) or recurrent tumor (three patients). Alkaline reflux esophagitis was found in three (43%) of seven patients who had a loop esophagojejunostomy. However, two (11%) of 19 patients with a Roux-en-Y esophagojejunostomy had relatively long strictures in the distal esophagus, apparently due to scarring from alkaline reflux esophagitis. Two patients (8%) had an afferent loop obstruction due to metastatic tumor and postsurgical scarring. Radiologists need to be familiar with the normal postoperative radiologic appearances and the radiologic findings of early and late complications associated with this procedure.