Arunas Gasparaitis

Duration of recurrent ileitis after ileocolonic resection correlates with presurgical extent of Crohn's disease.

Crohns disease of the terminal ileum recurs in a predictable sequence proximal to the ileocolonic anastomosis after surgical resection. To confirm the suspicion that the duration of recurrent ileitis correlates with the extent of presurgical disease, this study investigated 23 consecutive patients with recurrent Crohns disease symptoms who had undergone ileocaecal resections between 1982 and 1992 at our institution and had both preoperative and postoperative small bowel follow through studies available for comparison. All films were reviewed by a blinded gastrointestinal radiologist using uniform criteria. Symptomatic recurrence was reported at a mean (SEM) of 29 (25) months after resection. Presurgical length of inflammation averaged 26 (15) (8-57) cm and at recurrence 24 (14) (7-55) cm. The correlation coefficient (r) between pre and postsurgical extent of ileal disease was 0.70 (p < 0.0001). Seven patients had sequential small bowel series after 20 (10) (7-36) months without intervening surgery. The extent of measured inflammation between examinations correlated with r = 0.995 (p < 0.0001), showing the consistency of the measurement process. The close correlation between the duration of postoperative recurrence with the extent of presurgical disease is another example of individual patterns of recurrent Crohns disease and is an additional factor to be considered when contemplating surgical resections.

Duodenal Switch Gastric Bypass Surgery for Morbid Obesity: Imaging of Postsurgical Anatomy and Postoperative Gastrointestinal Complications

OBJECTIVE The purpose of our study was to evaluate the normal postsurgical findings and appearance of gastrointestinal tract complications in patients who have undergone biliopancreatic diversion with duodenal switch bariatric surgery. We performed a 4-year retrospective review of 218 patients who underwent duodenal switch surgery. CONCLUSION The most common complications of duodenal switch surgery were bowel obstruction, followed by ventral hernias and anastomotic leaks. Only 2% of cases required repeat surgery for management.

Enteroclysis and computed tomography enteroclysis

Enteroclysis, the most detailed radiologic examination of the small bowel, can be a challenge for both patient and radiologist. This article broadly outlines the principal technical features of the standard enteroclysis procedure and discusses its diagnostic advantages and indications, as well as its limitations and difficulties. A comparative assessment of computed tomography-enteroclysis and the emerging magnetic resonance adaptation complements the survey of current approaches to radiologic small bowel diagnostics.

Imaging Findings in Roux-en-O and Other Misconstructions : Rare but Serious Complications of Roux-en-Y Gastric Bypass Surgery

OBJECTIVE The purpose of this study was to present the clinical and imaging findings of Roux-en-O and other misconstructions of Roux-en-Y gastric bypass surgery. The more common complications of Roux-en-Y gastric bypass have been described in the literature. Complications secondary to misconstructions are rare and difficult to diagnose. CONCLUSION Roux-en-O or other misconstruction should be suspected in patients with chronic bilious vomiting after Roux-en-Y gastric bypass when no mechanical basis for obstruction can be identified. Fluoroscopic motility assessment is often critical in the diagnosis of these misconstructions.

Water Flush Technique: A Noninvasive Method of Optimizing Visualization of the Distal Esophagus in Patients With Primary Achalasia

OBJECTIVE The purpose of this study was to assess the use of a water flush technique to optimize visualization of the distal esophageal mucosa during barium esophagography of patients with moderate to severe primary achalasia. The water flush consists of having patients drink tap water at end esophagography in an attempt to clear the standing barium column. CONCLUSION The water flush technique is a simple, noninvasive maneuver that improves the extent of diagnostic visualization of the distal esophageal mucosa in patients with moderate to severe primary achalasia. It facilitated detection of a tumor in one patient and identification of additional pathologic changes in two other patients in this series.

Radiological Findings in Inflammatory Bowel Disease

Radiology has evolved dramatically since the 1950s. At that time, plain film radiography and single-contrast barium studies were the only imaging techniques available. In the 1960s, two developments occurred that gave rise to the subspecialty of gastrointestinal radiology; the introduction of image intensifiers and of double-contrast techniques. The images produced redefined the radiological diagnosis of diseases of the gastrointestinal (GI) tract (1). Double-contrast examinations are now the primary radiological modalities used in the investigation of inflammatory bowel disease (IBD).