Cerrahi sonrası anastomoz darlığı ve mide stazı

Özet

Parsiyel gastrektomi sonrası rezidü midede staz genellikle ileus veya perianastomotik duvar ödemine ikincil gelişir; sleeve darlığında kontrast geçişi gecikebilir veya durabilir. Sleeve stenozunda proksimal mide dilatasyonu görülebilir; kontrast pasajındaki gecikme veya durma dinamik üst gastrointestinal incelemede gösterilir ve bu inceleme darlık saptamada BT'den daha etkilidir. Hafif sleeve darlığında BT bulguları belirsiz kalabilir; dinamik üst gastrointestinal inceleme kontrast pasajını değerlendirir ve sleeve darlığını saptamada BT'den daha etkilidir.

Faz ve pencere

Portal tanısal

IV kontrastlı portal venöz kesitlerde gastrojejunostomi veya sleeve hattında fokal dar lümen, proksimal poş/rezidü mide genişlemesi, duvar ödemi ve çevresel kitle ya da inflamasyon aranır; oral kontrast varsa dar segmentten distal geçiş not edilir.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Gastrojejunostomi sonrası rezidü mide stazında mide genişleyebilir; sleeve darlığında proksimal mide dilatasyonu görülebilir ve kontrast pasajı gecikebilir veya durabilir.
• Daralmanın proksimalinde sıvı veya oral kontrast birikmiş mide poşu genişlemesi
• Oral kontrastın darlık seviyesinde gecikmesi veya distaldeki jejunuma geçişinin sınırlı olması
• Sleeve incisura angularis düzeyinde açılanma, bükülme veya segmenter kanal incelmesi
• Stapler hattı çevresinde ödem veya geçici serum birikimi görülebilir; bu durum erken dönemde normal iyileşme değişkenliği veya küçük bir kaçağı yansıtabilir.
• Gastrik cerrahi sonrası neoplastik hastalık nüksü geç dönem komplikasyonlar arasında yer alır.
• Dar segmentin dışından lümene basan komşu koleksiyon, hematom veya kitle
• Distal bağırsak anslarının kalibresi — tek seviyeli mide çıkış tıkanmasını yaygın ince bağırsak obstrüksiyonundan ayırır

Normalde

Gastrojejunostomide kontrastlı incelemede anastomozun açık ve obstrüksiyonsuz olduğu, kontrastın efferent veya Roux ansa ilerlediği değerlendirilir. Komplikasyonsuz BT'de sleeve tüp şeklinde, stapler hattı ise büyük kurvatur boyunca izlenir; değerlendirmede incisura angularis çevresi ve proksimal mide dilatasyonu da incelenir.

Ayırıcı tanı

Erken postoperatif ödem

kısa segment yumuşak duvar kalınlaşması yapabilir; cerrahiden hemen sonra belirgin olup zaman içinde gerilemesi beklenir.

Sleeve torsiyonunda proksimal sleeve dilatasyonu ve kontrast pasajında gecikme ya da durma görülebilir; üst gastrointestinal incelemede stapler hattı kıvrımlı seyir gösterir.

Anastomotik ülser, Roux-en-Y gastrik bypass sonrası görülebilen komplikasyonlardan biridir.

Gastrik cerrahi sonrası neoplastik hastalık nüksü geç dönem komplikasyonlar arasında yer alır.

Mide bezoarı, mide cerrahisi sonrası görülebilen komplikasyonlardan biridir.

Tuzaklar

• Üst GIS veya BT'de sleeve şekil varyasyonları (üst torba paterni gibi) kaçak veya reflüyle karışabilir; bu nedenle anatomik varyantlar ve klinik tablo birlikte değerlendirilmelidir.
• Oral kontrast anastomoza ulaşmadıysa distal geçişin görünmemesi darlığı kanıtlamaz; opaklaşmış son lümen segmentini tanımla.
• Normal erken iyileşme ödemi darlığı taklit edebilir; cerrahi zamanı, daralmanın uzunluğunu ve proksimal stazı birlikte değerlendir.
• BT'de belirgin geçiş noktası olmayışı hafif veya işlevsel darlığı dışlamaz; klinik şüphe sürüyorsa dinamik üst GIS incelemesi ya da endoskopi korelasyonu gerekir.

Kendini dene

1. Parsiyel gastrektomi sonrası mide stazı genellikle hangi iki durumla ilişkilidir?

   • İleus veya perianastomotik duvar ödemi
   • Splenik infarkt veya pankreatit
   • Anastomotik kaçak veya omental infarkt
   • Afferent ans genişlemesi veya dumping sendromu
   Cevabı göster

   İleus veya perianastomotik duvar ödemi. Kaynak, rezidü midede mide stazının genellikle ileus veya perianastomotik duvar ödemine ikincil olduğunu belirtir.

2. Sleeve sonrası BT'de belirgin geçiş noktası saptanmıyor, ancak darlık şüphesi sürüyor. Hangi yöntem kontrastın kanal boyunca dinamik pasajını doğrudan değerlendirir?

   • Üst gastrointestinal kontrastlı floroskopi
   • Akciğer grafisi
   • Kontrastsız batın BT
   • Üriner sistem ultrasonografisi
   Cevabı göster

   Üst gastrointestinal kontrastlı floroskopi. Üst gastrointestinal floroskopi kontrast pasajını dinamik olarak gösterir ve hafif ya da işlevsel sleeve darlığında BT'den daha duyarlı olabilir. BT çevre dokuları ve belirgin proksimal genişlemeyi gösterir, ancak dinamik pasaj değerlendirmesi sağlamaz.

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 14 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.