E2316. Down the GI Tract: Postoperative Imaging and Complications of Bariatric Surgery
  1. Seon Woo Kim; Weill Cornell Medicine - Qatar
  2. Heta Ladumor; University of Arkansas for Medical Sciences
  3. Sushila Ladumor; Hamad Medical Corporation
Bariatric surgery has increasingly gained popularity due to its effectiveness in sustainably treating obesity and associated comorbidities, improving patients’ quality of life, and reducing mortality. However, bariatric surgery brings possibilities of complications that can be unique. Not only is the normal anatomy altered, but also patients with postoperative complications may not display obvious clinical pictures. To avoid delayed diagnosis and potentially catastrophic consequences, simple signs such as tachycardia should alert the physician. Promptly obtained imaging in such a case plays an essential role in diagnosis. This guide highlights normal postoperative findings as well as imaging features of early and late complications of common bariatric surgeries.

Educational Goals / Teaching Points
Briefly review common types of bariatric surgery, including postsurgical anatomy, describe expected normal post-operative imaging appearance, and describe clinical presentation and imaging features of early and late complications of common bariatric surgeries.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Introduction to bariatric surgery: indications, types and descriptions of surgical procedures (gastric sleeve, Roux-en-Y gastric bypass, gastric band) with resultant post-operative anatomy. Expected postoperative appearance on CT: post-operative fluid and gas, hemostatic material, and surgical clips. Common complications of bariatric surgeries: 1. early: anastomotic leak (initiates cascade of abscess and, possibly, fistula formation), stenosis, bleeding, and venous thromboembolic event; 2. late: gallstones, chronic fistula (gastroenteric, gastrocolic, and gastrobronchial). Specific late complications of bariatric surgeries: 1. gastric sleeve: hiatal hernia, reflux, and stricture; 2. roux-en-Y gastric bypass: marginal ulcers (resulting in perforation or bleeding), small bowel obstruction, internal hernia, and jejuno-jejunal intussusception; and 3. adjustable gastric band: band slippage, band erosion, ischemia, and pseudoachalasia.

This guide describes imaging appearances of expected anatomy after bariatric surgery as well as imaging features of early and late complications. It is important to accurately distinguish expected postsurgical anatomy from pathological findings in bariatric patients, who may not display overt signs and symptoms of postoperative complications.