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Using Radiography to Reveal Chronic Jejunal Ischemia as a Complication of Gastric Bypass Surgery

Ross Silver1, Marc S. Levine1, Noel N. Williams2 and Stephen E. Rubesin1

1 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
2 Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104.



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  		Fig. 1A. —45-year-old woman with giant ulcer in jejunum after gastric bypass surgery. Right posterior oblique spot radiograph from single-contrast upper gastrointestinal tract study shows 3-cm ulcer (long straight arrows) in proximal jejunum abutting gastrojejunal anastomosis (short straight arrow). Note narrowing of anastomosis, most likely related to edema and spasm associated with ulcer crater. Endoscopy (not shown) confirmed presence of ulcer with ischemic-appearing mucosa in this region. Also note gastric pouch (curved arrow).

 


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  		Fig. 1B. —45-year-old woman with giant ulcer in jejunum after gastric bypass surgery. Right posterior oblique spot radiograph from follow-up single-contrast upper gastrointestinal tract study performed 3 months after A shows 1.5-cm jejunal ulcer (straight arrow). Note gastric pouch (curved arrow).

 


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  		Fig. 2. —43-year-old woman with ischemic stricture in jejunum after gastric bypass surgery. Frontal spot radiograph from single-contrast upper gastrointestinal tract study shows long segment of tubular narrowing (arrowheads) in proximal jejunum with smooth contour and effaced folds. Note short segment of relative sparing (arrow) in region of narrowing. At surgery, patient was found to have ischemic stricture in proximal jejunum.

 

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