Sequelae of stomach surgery

Gastric surgery has undergone continuous evolution since the 19th century. At present it is a highly sophisticated technique which provides symptomatic relief for the vast majority of patients operated upon for peptic ulcer disease. Although the overall incidence of complications has decreased, a variety of complications continues to occur and radiological examination plays a critical role in their detection, evaluation, and management. Knowledge of the variations in surgical terminology and commonly used eponyms provides the basic framework for discussion. Familiarity with the radiological appearance of the normal postoperative stomach together with an understanding of its physiology are essential prerequisites to the recognition of possible complications. Operative techniques may result in a radiographic appearance which simulates disease. Conditions as diverse as bezoars, afferent and efferent loop problems, marginal ulceration, anastomotic leakage, prolapse, and intussuception may all be characterized by distinct and highly specific radiographic changes. Physiologic problems such as dumping and malabsorption may also reflect their presence by X-ray changes. The radiographic features in a large number of surgical complications are discussed and illustrated. The importance of the radiographic examination in the postsurgical stomach is emphasized.