The operated stomach

X-ray examination of the stomach in the first days after the operation is mainly due to possible immediate postoperative complications. Due to the short period of time passed after the operation, the application of the research with the administration of contrast medium is undesirable and should be limited to conventional radiography. This reveals the presence or absence of pathological accumulation of gases in the intestines, the state of the lung parenchyma and subphrenic region. In the first days after the operation can be observed postoperative pneumoperitoneum.
At a later date after the operation with the help of x-ray studies can answer a number of practically important questions on the methodology applied surgical intervention, the functions of operated stomach, postoperative morphological changes on the part of the stomach as a whole and relief of the mucous membrane in particular and, finally, about the presence or absence of complications after surgery.
Usually after the imposition of gastrojejunostomy form of the stomach does not change. Fistula radiographically is located above the lower pole of the stomach. In the absence of a narrowing of the pyloric contrast weight first flows through the gatekeeper, and then, if the function of the anastomosis is performed properly, the stomach should be emptied mainly through the anastomosis. Located in highly fistula and wide hole very quickly emptied the part of the stomach, which is located above fistula, while in the lower division contrast weight can be a long time to linger, especially at the low tone of the stomach. Fast or slow gastric emptying may depend on the degree of the width of fistula. Anastomosis represents not just a hole, through which contrast fluid mechanical flows from the stomach to the jejunum. When gastrojejunostomy observed rhythm reduction holes fistula, making mass enters the intestine gradually. This is also supported by observations in the experiment and in gastroscopy.
Depending on what occasion are imposed anastomoses, i.e. about whether ulcers or narrowing of the pyloric, there evacuation only through fistula or through both out - natural and through fistula. When a normally functioning fistula gastric emptying is within 1.5-2 hours. Emptying occurring at a later date, is considered pathological.
The mucosa of the stomach after surgery is being rebuilt, and folds have a direction to side anastomosis, passing in the discharge loop. The typical picture of poristosti of the figure, the characteristic of the small intestine, this place disappears. When gastrojejunostomy develop a kind of changes accompanied by distinctive features characteristic of the relief mucosal swelling and deformation of the folds. Most likely, swelling and deformation mucosa are not inflammatory, how many functional character, as in happy postoperative course there is often only the reorganization of the relief without the presence of nasal mucous membrane.
Radiographically you are able to establish whether the so-called "vicious circle", which consists in the fact that the mass circulates between the stomach and the duodenum, barely getting further into the small intestine. This significantly expands and squeezed outlet loop.
Resection of the stomach, performed by one of the modifications of operations Billroth, for each of its species has its radiological features.
When resection by Billroth I the usual direction of the food supply. After the operation, the size of the stomach is significantly reduced its location becomes high, and he more or less obliquely crosses the spine. The upper part of the duodenum is extended. Near the place resection on the lesser curvature of observed irregularities associated with stitches to reduce clearance holes in connection with the duodenum. When removing a small part of the antrum done on the operation indicate the absence of the duodenum and some deformation of the stomach. The evacuation of the stomach is often done quickly, and overruns and stretch the duodenum. Gastric emptying is rhythmically and lasts about 1.5, rarely 2 hours.
When resection by Billroth II stomach takes the form of a funnel. The stump of the stomach is located to the left of the spine. Contrast weight, passing through fistula, gives a typical picture of the lateral deviation of the loop to the left and down, and then just goes distribution contrast mass in the small intestine. In some cases there is a primary and short-filling afferent loop. The anastomosis is located in the lowest point of the gastric stump. Emptying stump proceeds quickly, peristalsis of it barely visible, and only if any of the obstacles (spasm) or when blocking stump palpation of peristalsis is deepening.
In the stomach resection of change of the relief mucosa are expressed to a lesser extent than in the gastrojejunostomy. Only when viewed 12-14 days after the operation there is a sharp changes associated with swelling and deformation of mucous, which gradually, but not completely fade away.
One of the most frequent complications on the operated stomach is a peptic ulcer of fistula and the initial part of the discharge loop jejunum, and on the site of anastomosis it occurs much less frequently than in the discharge of the loop.
A peptic ulcer is not easy to diagnose because of abrupt changes in the mucous membrane in the form of a massive swelling is not conducive to the identification of the main symptom is niches, but still in a well-supplied technology to achieve success.
Often niche can simulate various pockets and sinuses, which are formed as a result of suturing and due to post-operative deformation, perigastric and peritonita.
In rare observations noted perforated peptic postoperative ulcers in the colon with the formation of the above-described the x-ray pictures, characteristic for gastrointestinal fistula.