Skip to main content
SpringerLink
Log in

Emergency Imaging of the Bariatric Surgery Patient

  • Living reference work entry
  • First Online:
Atlas of Emergency Imaging from Head-to-Toe

  • 76 Accesses

Abstract

Bariatric surgery remains the only treatment for obesity with established outcomes and durable weight loss. Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric band (LAGB) are the most commonly performed surgeries and constitute over 90% of the procedures currently performed. Unfortunately, complications after these surgeries are relatively common, and many patients with surgical complications present acutely in the emergent setting. Imaging, computed tomography (CT) in particular, plays an important role in the care of the bariatric surgery patient by readily depicting postoperative complications and guiding further management. The most common complications of RYGB include gastrointestinal leak, postoperative hemorrhage, anastomotic stricture or ulceration, small bowel obstruction, hernia, and intussusception. Complications after SG include leak, hemorrhage, and gastric stricture. Finally, complications after LAGB include stomal stenosis, band slippage, band erosion, and port/tubing complications. The goal of this chapter is to review the normal postoperative appearance of these bariatric surgical procedures and discuss and illustrate the most commonly encountered surgical complications of each.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  1. O’Brien PE, Hindle A, Brennan L, et al. Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg. 2019;29(1):3–14.

    Article  PubMed  Google Scholar 

  2. Estimate of Bariatric Surgery Numbers, 2011–2018 [Internet]. American Society for Metabolic and Bariatric Surgery. 2018. Available from: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers

  3. Frager D, Medwid SW, Baer JW, et al. CT of small-bowel obstruction: value in establishing the diagnosis and determining the degree and cause. AJR Am J Roentgenol. 1994;162(1):37–41.

    Article  CAS  PubMed  Google Scholar 

  4. Swanson JO, Levine MS, Redfern RO, et al. Usefulness of high-density barium for detection of leaks after esophagogastrectomy, total gastrectomy, and total laryngectomy. AJR Am J Roentgenol. 2003;181(2):415–20.

    Article  PubMed  Google Scholar 

  5. Mbadiwe T, Prevatt E, Duerinckx A, et al. Assessing the value of routine upper gastrointestinal contrast studies following bariatric surgery: a systematic review and meta-analysis. Am J Surg. 2015;209(4):616–22.

    Article  PubMed  Google Scholar 

  6. Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology. 2014;270(2):327–41.

    Article  PubMed  Google Scholar 

  7. Fobi MAL, Lee H, Holness R, et al. Gastric bypass operation for obesity. World J Surg. 1998;22(9):925–35.

    Article  CAS  PubMed  Google Scholar 

  8. Gonzalez R, Sarr MG, Smith CD, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204(1):47–55.

    Article  PubMed  Google Scholar 

  9. Carucci LR, Turner MA, Conklin RC, et al. Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of postoperative extraluminal leaks with upper gastrointestinal series. Radiology. 2006;238(1):119–27.

    Article  PubMed  Google Scholar 

  10. Nguyen NT, Longoria M, Chalifoux S, et al. Gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2004;14(10):1308–12.

    Article  PubMed  Google Scholar 

  11. Pratt JSA. Roux-en-Y gastric bypass: stomal stenosis. In: Nguyen NT, De Maria EJ, Ikramuddin S, Hutter MM, editors. The sages manual: a practical guide to bariatric surgery. New York: Springer; 2008. p. 211–2.

    Chapter  Google Scholar 

  12. Dallal RM, Bailey LA. Ulcer disease after gastric bypass surgery. Surg Obes Relat Dis. 2006;2(4):455–9.

    Article  PubMed  Google Scholar 

  13. Scheirey CD, Scholz FJ, Shah PC, et al. Radiology of the laparoscopic Roux-en-Y gastric bypass procedure: conceptualization and precise interpretation of results. Radiographics. 2006;26(5):1355–71.

    Article  PubMed  Google Scholar 

  14. Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–61.

    Article  PubMed  Google Scholar 

  15. Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13(4):596–600.

    Article  PubMed  Google Scholar 

  16. Tucker ON, Escalante-Tattersfield T, Szomstein S, et al. The ABC system: a simplified classification system for small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(12):1549–54.

    Article  PubMed  Google Scholar 

  17. Clapp B. Small bowel obstruction after laparoscopic gastric bypass with nonclosure of mesenteric defects. JSLS. 2015;19(1).

    Google Scholar 

  18. Mitchell MT, Gasparaitis AE, Alverdy JC. Imaging findings in Roux-en-O and other misconstructions: rare but serious complications of Roux-en-Y gastric bypass surgery. AJR Am J Roentgenol. 2008;190(2):367–73.

    Article  PubMed  Google Scholar 

  19. Sunnapwar A, Sandrasegaran K, Menias CO, et al. Taxonomy and imaging spectrum of small bowel obstruction after Roux-en-Y gastric bypass surgery. AJR Am J Roentgenol. 2010;194(1):120–8.

    Article  PubMed  Google Scholar 

  20. Aguirre DA, Santosa AC, Casola G, et al. Abdominal Wall Hernias: imaging features, complications, and diagnostic pitfalls at multi–detector row CT. RadioGraphics. 2005;25(6):1501–20.

    Article  PubMed  Google Scholar 

  21. Luján JA, Frutos MD, Hernández Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity. Ann Surg. 2004;239(4):433–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13(3):350–4.

    Article  PubMed  Google Scholar 

  23. Ahmed AR, Rickards G, Husain S, et al. Trends in internal hernia incidence after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(12):1563–6.

    Article  PubMed  Google Scholar 

  24. Lockhart ME, Tessler FN, Canon CL, et al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol. 2007;188(3):745–50.

    Article  PubMed  Google Scholar 

  25. Carucci LR, Turner MA, Shaylor SD. Internal hernia following Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of radiographic findings at small-bowel examination. Radiology. 2009;251(3):762–70.

    Article  PubMed  Google Scholar 

  26. Simper SC, Erzinger JM, McKinlay RD, et al. Retrograde (reverse) jejunal intussusception might not be such a rare problem: a single group’s experience of 23 cases. Surg Obes Relat Dis. 2008;4(2):77–83.

    Article  PubMed  Google Scholar 

  27. Daellenbach L, Suter M. Jejunojejunal intussusception after Roux-en-Y gastric bypass: a review. Obes Surg. 2011;21(2):253–63.

    Article  PubMed  Google Scholar 

  28. Kim YH, Blake MA, Harisinghani MG, et al. Adult intestinal intussusception: CT appearances and identification of a causative lead point. RadioGraphics. 2006;26(3):733–44.

    Article  PubMed  Google Scholar 

  29. Stephenson D, Moon RC, Teixeira AF, et al. Intussusception after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2014;10(4):666–70.

    Article  PubMed  Google Scholar 

  30. Riaz RM, Myers DT, Williams TR. Multidetector CT imaging of bariatric surgical complications: a pictorial review. Abdom Radiol (NY). 2016;41(1):174–88.

    Article  Google Scholar 

  31. Gagner M, Deitel M, Kalberer TL, et al. The second international consensus summit for sleeve gastrectomy, March 19–21. Surg Obes Relat Dis. 2009;5(4):476–85.

    Article  PubMed  Google Scholar 

  32. Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2011;21(4):473–8.

    Article  PubMed  Google Scholar 

  33. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.

    Article  PubMed  Google Scholar 

  34. Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):287–93.

    Article  PubMed  Google Scholar 

  35. Sarkhosh K, Birch DW, Sharma A, et al. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Can J Surg. 56(5):347–52.

    Google Scholar 

  36. Deslauriers V, Beauchamp A, Garofalo F, et al. Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis. Surg Endosc. 2018;32(2):601–9.

    Article  PubMed  Google Scholar 

  37. Levy JL, Levine MS, Rubesin SE, et al. Stenosis of gastric sleeve after laparoscopic sleeve gastrectomy: clinical, radiographic and endoscopic findings. Br J Radiol. 2018;91(1089):20170702.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Spivak H, Anwar F, Burton S, et al. The Lap-Band system in the United States: one surgeon’s experience with 271 patients. Surg Endosc. 2004;18(2):198–202.

    Article  CAS  PubMed  Google Scholar 

  39. Mehanna MJ, Birjawi G, Moukaddam HA, et al. Complications of adjustable gastric banding, a radiological pictorial review. AJR Am J Roentgenol. 2006;186(2):522–34.

    Article  PubMed  Google Scholar 

  40. Swenson DW, Pietryga JA, Grand DJ, et al. Gastric band slippage: a case-controlled study comparing new and old radiographic signs of this important surgical complication. AJR Am J Roentgenol. 2014;203(1):10–6.

    Article  PubMed  Google Scholar 

  41. Sonavane SK, Menias CO, Kantawala KP, et al. Laparoscopic adjustable gastric banding: what radiologists need to know. RadioGraphics. 2012;32(4):1161–78.

    Article  PubMed  Google Scholar 

  42. Egan RJ, Monkhouse SJW, Meredith HE, et al. The reporting of gastric band slip and related complications; a review of the literature. Obes Surg. 2011;21(8):1280–8.

    Article  PubMed  Google Scholar 

  43. Kicska G, Levine MS, Raper SE, et al. Gastric volvulus after laparoscopic adjustable gastric banding for morbid obesity. AJR Am J Roentgenol. 2007;189(6):1469–72.

    Article  PubMed  Google Scholar 

  44. Manganiello M, Sarker S, Tempel M, et al. Management of slipped adjustable gastric bands. Surg Obes Relat Dis. 2008;4(4):534–8.

    Article  PubMed  Google Scholar 

  45. Cherian PT, Goussous G, Ashori F, et al. Band erosion after laparoscopic gastric banding: a retrospective analysis of 865 patients over 5 years. Surg Endosc. 2010;24(8):2031–8.

    Article  CAS  PubMed  Google Scholar 

  46. Chisholm J, Kitan N, Toouli J, et al. Gastric band erosion in 63 cases: endoscopic removal and rebanding evaluated. Obes Surg. 2011;21(11):1676–81.

    Article  PubMed  Google Scholar 

  47. Hainaux B, Agneessens E, Rubesova E, et al. Intragastric band erosion after laparoscopic adjustable gastric banding for morbid obesity: imaging characteristics of an underreported complication. AJR Am J Roentgenol. 2005;184(1):109–12.

    Article  PubMed  Google Scholar 

  48. Collado-Pacheco D, Rábago-Torre LR, Arias-Rivera M, et al. Endoscopic extraction of adjustable gastric bands after intragastric migration as a complication of bariatric surgery: technique and advice. Endosc Int Open. 2016;4(6):E673–7.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Blachar A, Blank A, Gavert N, et al. Laparoscopic adjustable gastric banding surgery for morbid obesity: imaging of normal anatomic features and postoperative gastrointestinal complications. AJR Am J Roentgenol. 2007;188(2):472–9.

    Article  PubMed  Google Scholar 

  50. Wiesner W, Schöb O, Hauser RS, et al. Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications. Radiology. 2000;216(2):389–94.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA

    Daniel R. Ludwig

  2. Mayo Clinic Department of Radiology, Scottsdale, AZ, USA

    Christine O. Menias

Authors
  1. Daniel R. Ludwig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine O. Menias
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel R. Ludwig .

Editor information

Editors and Affiliations

  1. Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, ON, Canada

    Michael N Patlas

  2. Department of Radiology, NYU Winthrop Hospital, Mineola, NY, USA

    Douglas S. Katz

  3. Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy

    Mariano Scaglione

Section Editor information

  1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA

    Vincent Mellnick MD

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Ludwig, D.R., Menias, C.O. (2021). Emergency Imaging of the Bariatric Surgery Patient. In: Patlas, M.N., Katz, D.S., Scaglione, M. (eds) Atlas of Emergency Imaging from Head-to-Toe. Springer, Cham. https://doi.org/10.1007/978-3-030-44092-3_34-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-44092-3_34-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-44092-3

  • Online ISBN: 978-3-030-44092-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation