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.

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

Original paper

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