48-year-old woman with Roux limb inversion.
(A) Patient was given medium-density barium in patient-controlled boluses. Spot image from initial fluoroscopic examination shows alimentary limb is dilated (arrowheads) but more distal small bowel is of normal caliber (arrow). Fluoroscopic assessment shows no definable cause at transition point.
(B) Radiograph 2 weeks after (A) shows persistence of contrast material in alimentary limb.
(C) Follow-up fluoroscopic examination was performed after bowel preparation to clear contrast material from alimentary limb. Image obtained after administration of medium-density barium through jejunal tube shows biliary limb of normal caliber. Peristalsis is antegrade within biliary limb. At distal anastomosis, divergent flow of contrast material is evident antegrade into common limb (white asterisk) and retrograde into alimentary limb (black asterisk). Thin arrows indicate direction of peristalsis.
(D) Spot image obtained minutes after (C) shows continued abnormal retrograde peristalsis (arrow) diverting contrast material farther up alimentary limb.
(E) After acquisition of (D), patient was given water-soluble contrast material orally in patient-controlled boluses. Spot image shows dilated gastric pouch (thick arrow) and flaccid and featureless proximal alimentary limb (arrowheads). Peristalsis was initially antegrade (thin arrows).
(F) Fluoroscopic image shows that with full distention of alimentary limb by contrast material, abrupt reversal of peristalsis (arrow) is evident with return of contrast material to gastric pouch and subsequent marked patient emesis, essentially reproducing symptoms of food intolerance.