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Illustration of Hartmann procedure. A sigmoidectomy (dashed white lines) is performed on an emergent basis with creation of a temporary diverting colostomy in left iliac fossa (white arrow) and closure of a blind-ending rectal stump (black arrow)
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The post-operative abdomen can be challenging and knowledge of normal post-operative anatomy is important for diagnosing complications. The aim of this pictorial essay is to describe a few selected common, major gastrointestinal surgeries, their clinical indications and depict their normal post-operative computed tomography (CT) appearance. This es...
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Citations
... According to the exteriorized segment, it receives different names; for example, if it is a colon it is called a colostomy, and if it is an ileum that it is called an ileostomy. It can be temporary or definitive [14][15][16][17] . ...
... The main function of the ostomy is the diversion of the intestinal contents, either for distal decompression in the event of an obstruction, or because there is no possibility of making a safe anastomosis of the digestive tract, or for the protection of a distal digestive anastomosis. It can also be used to protect an intestinal segment affected by disease, or by resection or failure of the anal sphincter apparatus [14][15][16][17] . ...
... De acuerdo con el segmento exteriorizado recibe diferentes nombres; por ejemplo, si es colon se denomina colostomía, y si es íleon se denomina ileostomía. Puede ser temporal o definitiva [14][15][16][17] . ...
... La función principal de la ostomía es la derivación del contenido intestinal, ya sea para la descompresión distal en el caso de una obstrucción, o porque no hay posibilidad de realizar una anastomosis segura del tracto digestivo, o para la protección de una anastomosis digestiva distal. También puede usarse para proteger un segmento intestinal afectado por una enfermedad, o por resección o falla del aparato esfinteriano anal [14][15][16][17] . Antecedente de neoplasia de colon operada, con lesiones sincrónicas en colon sigmoides y transverso. ...
The imaging evaluation of postoperated patients is often a challenge for the resident and the general radiologist, especially in those complex surgeries, in which the normal anatomy is usually altered. Adequate anatomical knowledge and familiarization with the surgical techniques of the most frequent lower digestive surgeries allow the radiologist to recognize the normal postsurgical anatomical changes (expected), achieving an adequate interpretation of the findings in computed tomography (CT), notably improving sensitivity and the performance to search for tumor recurrence and define its location, study of tumor extension and search for possible complications, such as abscesses, perforation, peritonitis, ischemia, intestinal obstruction, etc. that will guide the treatment. The objective of this review is to recall the different surgical techniques in lower digestive surgeries and their anatomical-radiological correlation in CT.
... The rationale for stoma creation may be relief of distal obstruction, protection of an anastomosis, temporary bypass or definite diversion of the faecal stream. Depending on the procedure and the indication, stomas can be either permanent or temporary [2][3][4]. ...
... Permanent end colostomies are created when the anorectum is removed such as during abdomino-perineal resection (APR) and when stoma reversal is not possible, such as for unresectable CRC or palliation of incontinence. The most common temporary end colostomy is created during Hartmann's surgery for acute diverticulitis or CRC of the sigmoid colon, when the closed rectal stump is left in place for future restoration of intestinal continuity [2][3][4]. ...
... After a variable delay (two to six months), temporary ileostomies are generally reversed (closed) to re-establish the intestinal continuity. Alternatively a double-barrelled colostomy may be created, which is similar to loop stomas because it has two openings, when after resection of a diseased tract both limbs are exteriorised at the same site at the abdominal wall [2][3][4]. ...
Nowadays, large numbers of ileostomies and colostomies are created during surgical management of a variety of intestinal disorders. Depending on indication, surgical technique and emergency versus elective conditions, stomas may be either temporary or permanent. As a result, patients with ileostomies and colostomies are commonly encountered in Radiology departments, particularly during perioperative hospitalisation following stoma creation or before recanalisation, and when needing CT or MRI studies for follow-up of operated tumours or chronic inflammatory bowel diseases. However, the stoma site is commonly overlooked on cross-sectional imaging.
Aiming to improve radiologists’ familiarity with stoma-related issues, this pictorial essay concisely reviews indications and surgical techniques for ileostomies and colostomies, and presents state-of-the art multimodal imaging in patients living with a stoma, including water-soluble contrast stomal enema (WSC-SE), CT and MRI techniques, interpretation and expected findings. Afterwards, the clinical features and imaging appearances of early and late stoma-related complications are illustrated with imaging examples, including diversion colitis.
When interpreting cross-sectional imaging studies, focused attention to the stoma site and awareness of expected appearances and of possible complications are required to avoid missing significant changes requiring clinical attention. Additionally, dedicated imaging techniques such as WSC-SE and combined CT plus WSC-SE may be helpful to provide surgeons the appropriate clinical information required to direct management.
... Benign patolojiler arasında divertiküler hastalık, polipozisler, inflamatuar barsak hastalığı, iskemik hastalık, rektal prolapsus; malign hastalıklar arasında ise başta adenokarsinom olmak üzere değişik kanser türleri sayılabilir. Birçok cerrahi yöntem ve teknik mevcut olup, uygulanacak cerrahi hastalığın tipi ve şiddeti, hastalığın yaygınlığının yanı sıra, cerrahın deneyim ve tercihine göre de şekillenmektedir [1]. Cerrahi yöntemlerdeki çeşitlilik, cerrahi sonrası görüntülemedeki normal ve anormal radyolojik bulgulara da yansımaktadır. ...
... Standart ameliyatlar dışında, farklı bir yöntem kullanılmış veya operasyon esnasında herhangi bir komplikasyon yaşanmış ise bunlar hakkında bilgi sahibi olunması da kritik öneme sahiptir. Ameliyat sonrası radyolojik değerlendirme gerektiren kuşkunun mutlaka öğrenilmesi, ayrıca ameliyat sonrası kaçıncı gün olduğunun da bilinmesi tanı doğruluğunu arttıracak önemli unsurlar arasındadır [1,2]. ...
... Anterior rectal resection (ARR) involves removal of the distal sigmoid colon, recto-sigmoid junction and most of the rectum and may be reconstructed with either a coloanal (in low ARR) or colorectal anastomosis with the preserved terminal rectum. After standard (Fig. 3) or extended left colectomy, a long colonic segment is removed, extending from the sigmoid to the splenic flexure or transverse colon respectively, with the hepatic flexure at its normal site [18][19][20]. ...
... End-to-side anastomoses are used when a smaller proximal lumen is connected to a larger one such as after standard (Fig. 4) or extended right colectomy: in these cases WE-MDCT shows absence of the right colon from the terminal ileum through the hepatic flexure or transverse colon, respectively. Moreover, subtotal colectomy (indicated to treat ulcerative colitis, fulminant infectious colitis, synchronous malignancies and hereditary polyposis syndromes) may be completed with either a permanent or temporary ileostomy or an end-to-side anastomosis between the preserved rectum and distal ileum (Fig. 5) [18][19][20]. ...
... Following ICR for CD, the ileocolic anastomosis is frequently of the end-to-side or side-to-side type with a distended, prominent colonic blind end (Bcul-de-sac^) (Fig. 6). Finally, WE-MDCT is also useful to assess the large bowel after extra-colonic abdominal and pelvic surgeries that may cause repositioning, extrinsic compression of the colon or both (Fig. 7) [18][19][20]. ...
Water-enema multidetector CT (WE-MDCT) provides a detailed multiplanar visualisation of mural, intra- and extraluminal abnormalities of the large bowel, relying on preliminary bowel cleansing, retrograde luminal distension, pharmacological hypotonisation and intravenous contrast enhancement. In patients with a history of colorectal surgery for either carcinoma or Crohn's disease (CD), WE-MDCT may also be performed via a colostomy, which allows depicting the anatomy and position of the residual large bowel and evaluates the calibre, length, mural and extraluminal features of luminal strictures. Therefore, WE-MDCT may prove useful as a complementary technique after incomplete or inconclusive colonoscopy to assess features and suspected abnormalities of the surgical anastomosis, particularly when endoscopic or surgical interventions are being planned. This pictorial essay presents the WE-MDCT technique and pitfalls, the expected appearances after different colic surgeries and the imaging features of benign anastomotic disorders (fibrotic stricture, kinking, inflammatory ulcer) and of locally recurrent tumours and CD.
Teaching points:
• Water-enema multidetector CT (WE-MDCT) effectively visualises the operated colon • Complementary to endoscopy, WE-MDCT may helpfully depict abnormalities of surgical anastomoses • WE-MDCT allows assessment of strictures' features and abnormalities of the upstream bowel • Technical pitfalls, normal postsurgical findings and benign anastomotic disorders are presented • WE-MDCT allows detecting relapsing Crohn's disease, recurrent and metachronous tumours.
... On the fifth postoperative day (POD) after uncomplicated total gastrectomy with lymphadenectomy and splenectomy, contrast fluoroscopy (CF, B) showed normally patent, thin EJS (arrowhead) with opacification of jejunal limb and no anastomotic contrast medium leakage. Corresponding expected postsurgical contrast-enhanced CT (C, D) appearances at hospital discharge included stapled EJS (arrowheads) without peri-anastomotic air or fluid, absent spleen without collections in the surgical site and division of the stomach at least 6 cm from any macroscopic tumour [2][3][4][5]13]. ...
... Bhigh^subtotal gastrectomy the small-sized gastric remnant is connected to a Roux-en-Y gastrojejunostomy (GJS) (Fig. 1b), Blow^partial gastrectomy with preservation of the gastric fundus may be reconstructed using a Billroth II GJS ( Fig. 1c) technique, with DS directly connected to the remnant stomach. According to the surgeon's preference, anastomoses may be either hand-sewn or stapled [5,13,16]. In a 62-year-old male, CF performed five days after uncomplicated partial gastrectomy showed opacified, moderately dilated remnant stomach, slow transit of iodinated contrast through the GJS (arrowheads) and opacified Roux-en-Y anastomotic recess (*) Fig. 3 In a 74-year-old male, preoperative CT (A) depicted a stricturing carcinoma of the gastric body (thick arrow). ...
Teaching points:
• Radical gastrectomy is associated with frequent postoperative morbidity and non-negligible mortality. • In cooperative patients fluoroscopy allows checking for anastomotic patency and leaks. • Multidetector CT with / without oral contrast comprehensively visualizes the operated abdomen. • Awareness of surgically altered anatomy and expected postoperative appearances is warranted. • Main complications include anastomotic and duodenal leaks, haemorrhages and pancreatic fistulas.
Complications after surgery for colorectal cancer are common in emergency departments. Multidetector computed tomography plays a fundamental role in the follow-up of patients after surgery, because it enables the detection of relapse and complications. Radiologists need to be familiar with different surgical techniques and the normal postsurgical changes so that we can differentiate them from potential complications and relapse.
This article reviews the multidetector computed tomography findings that can be considered normal after surgical intervention for colorectal cancer as well as the most common early complications seen in postsurgical colorectal cancer patients presenting at emergency departments.
Resumen
Las complicaciones posquirúrgicas del cáncer colorrectal son frecuentes en los servicios de urgencias. La tomografía computarizada multidetector tiene un papel fundamental en el seguimiento de los pacientes operados, ya que hace posible el reconocimiento de complicaciones y recidiva. Es importante que el radiólogo esté familiarizado con las diferentes técnicas quirúrgicas y los cambios postoperatorios normales, con objeto de diferenciarlas de potenciales complicaciones y recidivas.
El objetivo de este trabajo es revisar los hallazgos en tomografía computarizada multidetector que pueden considerarse normales tras la intervención quirúrgica, y hacer una revisión de las complicaciones tempranas que con mayor frecuencia encontramos en los servicios de urgencias.
Postsurgical bile leaks can be associated with significant morbidity and even mortality, if not identified and treated at an early phase. Hepatobiliary iminodiacetic acid (HIDA) scan is an important test for detection of bile leaks in the postoperative abdomen. However, the lack of anatomical details on planar images can make interpretation difficult, especially in the setting of altered postsurgical anatomy. Familiarity with the expected postoperative appearance on HIDA scan and correlation with SPECT/CT or other imaging modalities when available are very important. The purpose of this review is to describe the expected findings on HIDA scan after common major abdominal surgeries that involve a change in biliary tree anatomy, and illustrate how to identify biliary leaks and avoid interpretation pitfalls.
