IMAGING OF PATIENTS WITH PANCREATICOBILIARY DIVERSION FOR OBESITY - POSTOPERATIVE ANATOMY AND FINDINGS IN SMALL-BOWEL OBSTRUCTION

Pancreaticobiliary diversion is a surgical procedure undertaken for ob esity. It consists of a distal gastrectomy with a long Roux-en-Y recon struction, the enteroenterostomy being placed 200 cm distal to the gas troenterostomy and 50 cm proximal to the ileocaecal valve. Three intes tinal limbs are recognized: (a) the alimentary loop from the gastroent erostomy to the enteroenterostomy; (b) common loop from the enteroente rostomy to the ileocaecal valve and (c) pancreaticobiliary loop from t he duodenum to the enteroenterostomy. The radiological findings in 15 pancreaticobiliary diversion patients with small bowel obstruction wer e reviewed (15 plain abdominal radiographs, 13 ultrasound (US), 8 CT) and compared with 20 plain abdominal radiographs, 10 US, and 10 CT stu dies performed for other causes in patients with pancreaticobiliary di version and 15 CT scans from non-operated patients. After pancreaticob iliary diversion the pancreaticobiliary loop was completely air-free. In the patients operated on more than 1 year previously, alimentary an d common loops were significantly larger than the pancreaticobiliary l oop and small bowel loops of non-operated subjects. Obstruction of the pancreaticobiliary loop arrests only the flow of pancreaticobiliary S ecretions with non-specific clinical findings. Plain abdominal radiogr aphs were not diagnostic in all but two cases with radiographically de tectable dilated fluid filled loops. Air-fluid levels were never appar ent. US and CT showed markedly dilatated intestinal loops and duodenum . Obstruction of the alimentary and common loops presented with sympto ms, clinical signs, and radiological findings more typical for bowel o bstruction in intact subjects.