Silicon Ring Vertical Gastroplasty for Morbid Obesity
Spectrum of Radiologic Findings
Niloufar Sadeghi1,
Jean Closset2,
Jean-Jacques Houben2,
Julien Struyven1 and
Marc Zalcman1
1
Department of Diagnostic Radiology, Hôpital
Erasme, Université Libre de Bruxelles, 808
Rte. de Lennik, 1070, Brussels, Belgium.
2
Department of Gastrointestinal Surgery, Hôpital
Erasme, Université Libre de Bruxelles, 1070,
Brussels, Belgium.
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Fig. 1. —Diagram illustrating configuration of stomach after silicon ring
vertical gastroplasty. Gastric pouch (short solid arrows) is
separated from distal stomach (open arrows) by four rows of staples
(arrowheads). Note stoma with silicon ring (long solid
arrow) around it.
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Fig. 2A. —Normal early postoperative appearance of silicon ring vertical
gastroplasty in 27-year-old woman with morbid obesity who underwent silicon
ring vertical gastroplasty 3 days earlier. Single-contrast radiograph of
stomach obtained with patient in upright position shows gastric pouch that is
opacified and empties into distal stomach through stoma (arrow)
without significant delay.
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Fig. 2B. —Normal early postoperative appearance of silicon ring vertical
gastroplasty in 27-year-old woman with morbid obesity who underwent silicon
ring vertical gastroplasty 3 days earlier. Single-contrast radiograph obtained
with patient in supine position shows line of staples outlined by contrast
material (arrowheads) with no disruption.
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Fig. 3. —Normal late postoperative appearance of silicon ring vertical
gastroplasty in 30-year-old woman who underwent vertical gastroplasty 2 years
earlier for morbid obesity. Double-contrast radiograph shows gastric pouch,
which is oblong in shape. Stoma is 1 cm in diameter (arrowheads).
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Fig. 4. —Normal late postoperative appearance of silicon ring vertical
gastroplasty in 28-year-old woman with morbid obesity who underwent vertical
gastroplasty 3 years earlier. Double-contrast radiograph shows row of vertical
staple lines separating excluded fundus from pouch (arrowheads).
Mucosal relief is also evident.
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Fig. 5. —Early stomal narrowing in 40-year-old woman with morbid obesity who
underwent vertical gastroplasty 3 days earlier. Single-contrast radiograph
reveals stomal edema and early narrowing (arrow). Gastric pouch
emptying into distal stomach is significantly delayed. Nasogastric tube is
also seen in stomal lumen (arrowheads).
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Fig. 6. —Gastric perforation after vertical gastroplasty in 51-year-old woman
with morbid obesity who underwent surgery 3 days earlier. Single-contrast
radiograph shows contrast leak from superior part of staple lines
(arrow).
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Fig. 7. —Gastric perforation after vertical gastroplasty in 42-year-old woman
who presented with pain and fever on 12th day after surgery for morbid
obesity. Contrast-enhanced CT scan of upper abdomen shows large air and fluid
collection (arrows). Row of staples can also be identified
(arrowhead).
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Fig. 8. —Early staple-line disruption in 31-year-old woman who underwent
vertical gastroplasty for morbid obesity 3 days earlier. Single-contrast
radiograph identifies two sites of disruption on superior part of staple lines
(arrowheads).
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Fig. 9. —Late stomal narrowing in 52-year-old woman who presented with food
intolerance and vomiting 2 years after vertical gastroplasty. Double-contrast
radiograph shows stomal narrowing (arrow) with moderately dilated
pouch. Staple lines are also well visualized and there is no disruption.
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Fig. 10. —Late stomal narrowing and horizontalization with pouch dilatation in
39-year-old woman who presented with food intolerance and vomiting 3 years
after vertical gastroplasty for morbid obesity. Single-contrast radiograph
shows stomal horizontalization (arrow) and pouch dilatation
(arrowheads) caused by stomal narrowing with patent cardia and
gastroesophageal reflux.
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Fig. 11. —Stomal widening in 53-year-old woman who presented with weight gain
2 years after vertical gastroplasty for morbid obesity. Double-contrast
radiograph shows enlarged stoma (arrowheads) with rapid emptying of
pouch.
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Fig. 12. —Stomal widening in 52-year-old woman who presented with weight gain
2 years after vertical gastroplasty for morbid obesity. Double-contrast
radiograph shows small pouch (arrows). Pouch emptying was also
accelerated by stomal widening in this patient.
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Fig. 13. —Late staple-line disruption in 30-year-old woman who presented with
weight gain 2 years after vertical gastroplasty for morbid obesity.
Double-contrast radiograph of stomach shows large zone of disruption in
inferior portion of staple lines (arrowheads). Stoma cannot be
visualized on this image.
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Fig. 14. —Bezoar in 53-year-old woman who presented with acute episodes of
vomiting 5 years after vertical gastroplasty for morbid obesity.
Single-contrast radiograph shows large barium-coated bezoar in dependent
portion of gastric pouch (arrows), causing outlet obstruction
(arrowhead).
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Fig. 15. —Gastric perforation after stomal dilatation in 32-year-old woman who
underwent endoscopic stomal dilatation for stomal narrowing 3 years after
surgery for morbid obesity. Single-contrast radiograph obtained immediately
after endoscopic dilatation shows extravasation of contrast material at site
of dilatation (arrow).
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Copyright © 2000 by the American Roentgen Ray Society.
