E2583. Bilroth, Sleeve, Roux-en-Y, Oh My! An Image-Based Review of Upper GI Postsurgical Anatomy and Common Complications
  1. Julia Saltalamacchia; Oregon Health and Science University
  2. Alice Fung; Oregon Health and Science University
  3. Elena Korngold; Oregon Health and Science University
Understanding the anatomy of common and complex surgical reconstructions within the upper gastrointestinal (GI) system is crucial for radiologists to identify common complications and provide insight and value to our referring surgeons. However, the multitude of reconstruction types and techniques can be overwhelming to identify and differentiate. This review aims to offer a review of common and more complex postsurgical appearance of the upper GI tract and to provide a framework for problem-solving unknown postsurgical anatomy and common complications.

Educational Goals / Teaching Points
There are several ways to categorize the typical surgeries of the upper GI tract. One commonly used classification is benign and oncologic surgeries, with the benign categories including bariatric surgeries (Roux en Y gastric bypass and sleeve gastrectomy), surgeries for peptic ulcer disease (including Bilroth 1 and 2 reconstructions), and upper GI surgery in the setting of trauma or prior surgical complication including hepaticojejunostomy after common bile duct injury or leak during cholecystectomy or liver transplant. Oncology-related surgeries include partial and subtotal gastrectomies with reconstruction and pancreatoduodenectomies. This review suggests considering the reason for resection and the type of reconstruction as separate entities, with the type of reconstruction most relevant to imaging interpretation. The principal component of the majority of upper GI reconstructions includes a gastrojejunostomy with or without a pancreatobiliary or afferent limb. Understanding the reconstructed anatomic connections between the GI tract, the biliary tree, and the pancreas are crucial to interpreting routine postoperative imaging and postoperative complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Complications to consider for all gastrojejunostomies and jejunojejunostomies include marginal ulcers, anastomotic dehiscence/leak, and stricture. Reconstructions with a Roux-en-Y type configuration, including pancreatoduodenectomy and hepaticojejunostomy are also susceptible to afferent limb syndrome. Such reconstructions may also be susceptible to dumping syndrome and malabsorption (though the manifestations of such are less relevant to imaging interpretation). Partial gastrectomies and wedge gastric resections are subject to fewer complications because they retain the native functional anatomy.

The goal of this exhibit is to provide a framework for understanding upper GI reconstructions, review the relevant anatomy, functionality, normal postoperative imaging appearance, and discuss the imaging appearance of common postoperative complications via a cased-based approach.