A Primer to Common Major GI Post-surgical Anatomy on CT
Summarized by: Sakib Kazi, M.D.
Reviewed by: Ameya Kulkarni, M.D.
Original publication details
Authors: Terrone, D. G., Lepanto, L., Billiard, J. S., Olivié, D., Murphy-Lavallée, J., Vandenbroucke, F., & Tang, A.
DOI: 10.1007/s13244-011-0121-4
Reference: Terrone, D. G., Lepanto, L., Billiard, J. S., Olivié, D., Murphy-Lavallée, J., Vandenbroucke, F., & Tang, A. (2011). A primer to common major gastrointestinal post-surgical anatomy on CT-a pictorial review. Insights into imaging, 2(6), 631–638. https://doi.org/10.1007/s13244-011-0121-4
Gastric Surgeries
Billroth 1
Partial gastrectomy with gastroduodenostomy
Billroth 2
Partial gastrectomy with gastrojejunostomy
Gastrojejunostomy may be ante- or retro- colic
Bariatric surgery
Restrictive
Creation of small pouch to induce weight loss through satiety
Examples: adjustable gastric banding, vertical-banded gastroplasty
Malabsorptive
Bypass portions of the small bowel to limit digestion and absorption
Examples: jejuno-ileal bypass, biliopancreatic diversion with/without duodenal switch
Roux-en-Y gastric bypass
Combines Restrictive (small gastric pouch) and malabsorptive (roux limb):
Whipple
Indications: Pancreatic cancer, periampullary neoplasms, chronic pancreatitis, pancreatic trauma
Radical resection of pancreatic head, duodenum, gastric antrum
Creation of gastrojejunostomy, choledochojejunostomy, and pancraticojejunostomy
Pancreas
Puestow
Indications: Intractable chronic pancreatitis with duct dilation >6mm
Pancreas is incised longitudinally to expose the main pancreatic duct. Roux-en-Y loop of jejunum brought for creation of pancreaticojejunostomy with direct drainage of the pancreatic duct into jejunum.
Ileal pouch-anal anastomosis
Indications: Preserves fecal continence in patients requiring proctocolectomy
Colectomy and proctectomy → distal end of ileum stapled to form blind end stump → distal ileum folded on itself to create apical enterotomy → side to side anastomosis of two ileal loops (pouch) → anastomosis between anus and enterotomy → temporary diverting loop ileostomy
CT findings: staple line at blind end of distal ileum, parallel staple lines along ileal pouch, staple line circle at ileal pouch – anal anastomosis
Small bowel
Hartmann
Indications: diverticulitis, sigmoid cancer, penetrating trauma
Performed after partial colectomy or sigmoidectomy
Creation of temporary colostomy + blind ending rectal/colonic stump
Colorectal
Lower anterior resection
Indications: rectosigmoid and proximal rectum lesions >5cm away from anal border
Resection of distal left colon, sigmoid and proximal rectum
Low colo-rectal anastamosis
Abdomino-perineal resection
Indications: distal rectum lesions <5cm away from anal border
Resection of distal descending colon, sigmoid rectum, and anus
Permanent end colostomy
Citation
Terrone, D. G., Lepanto, L., Billiard, J. S., Olivié, D., Murphy-Lavallée, J., Vandenbroucke, F., & Tang, A. (2011). A primer to common major gastrointestinal post-surgical anatomy on CT-a pictorial review. Insights into imaging, 2(6), 631–638. https://doi.org/10.1007/s13244-011-0121-4