Fig. 14
From: Early postoperative imaging after non-bariatric gastric resection: a primer for radiologists
A 59-year-old male with cardial carcinoma underwent total gastrectomy. Early postoperative CF (A) showed patent EJS (arrowhead) with perianastomotic contrast leakage (*) directed medially. Bilateral pleural drainages were positioned to relieve minimal right pneumothorax and left hydropneumothorax (B). On 10th POD contrast-enhanced CT with oral contrast (C, D) confirmed ample left-sided hydropneumothorax with enhancing pleural surface. Extraluminal contrast leakage (*) was seen both medially to the EJS (arrowheads) and dependent in the left pleural empyema. Repeated CT obtained in the right lateral decubitus position (E) before CT-guided pleural drainage confirmed anastomotic fistula from the EJS (arrowhead) to the hydropneumothorax, which was treated by endoscopic clipping (arrowhead in F); note pleural pigtail drainage