Disconnected Roux-en-O misconstruction

52-year-old woman with disconnected Roux-en-O misconstruction.
(A-C) Axial reconstruction CT scans show levels of gastric pouch (A), descending duodenum (B), and distal anastomosis (C). Enteric contrast medium administered orally opacifies markedly dilated gastric pouch (black asterisk, A), alimentary limb (short arrows, B and C), and extruded stomach and biliary limb (white asterisks). Common limb, beginning at supposed distal anastomosis (long arrow, C), distal small bowel, and colon (arrowheads, B and C) are collapsed and gasless. At surgery, biliary limb was found to have been incorrectly anastomosed to gastric pouch, forming Roux-en-O loop that ran from gastric pouch to end blindly in excluded distal stomach. Distal portion of bowel is collapsed and gasless because common limb was completely disconnected from Roux loop.