60-year-old man with connected Roux-en-O misconstruction.
(A) Representative axial CT scan through upper abdomen shows nonspecific mild dilatation of upper abdominal bowel loops (thick arrows). Ileum (thin arrow) and colon (arrowheads) are unremarkable. Gastrojejunostomy tube placed in excluded gastric segment is partially evident within transverse duodenum.
(B) Patient was given medium-density barium in serial patient-controlled swallows during fluoroscopic observation. Early spot image of gastric pouch (thick arrow) shows patent proximal anastomosis (paired thin arrows) and normal-caliber alimentary limb (arrowheads). Small collection of contrast material lateral to pouch (single thin arrow) is residual contrast agent from earlier anastomotic leak that had healed.
(C) Fluoroscopic spot image of alimentary limb during initial filling shows normal bowel caliber. Mild indentation of alimentary limb as it goes through transverse mesocolon (arrow) is evident. Residual enteric contrast material from previous CT examination faintly opacifies colon.
(D) Fluoroscopic spot image of distal alimentary limb shows mild to moderate dilatation of limb. Antegrade contrast flow is by gravity only with no peristaltic activity observed. Most contrast material has reached distal alimentary limb (arrowheads).
(E) Fifteen-minute-delayed fluoroscopic spot image of alimentary limb shows retrograde peristalsis (arrows) with return of considerable amount of contrast material into dilated proximal alimentary limb (arrowheads). Fluoroscopy showed contrast material eventually reaching gastric pouch (not shown).