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