PMC6288317_01
Patient 1, prior to surgery. Herniation of the distended stomach into the thoracic cavity. The dilatation above and below diaphragm is shown.
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CT scan revealed that proximal 2/3 of the stomach was herniated into the left hemithorax (Fig. 1).
Patient 1. CT on second postop. day. Infarction in the left liver lobe (1) and the spleen (2) with neighbouring fluid collection (3).
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A repeat CT scan postoperatively demonstrated abdominal fluid and infarctions of the upper part of the spleen and peripherally in the left liver lobe (Fig. 2).
Patient 1. CT on second postop day. Lack of perfusion (arrow) of a distal segment of the pancreatic body.
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There was also lack of perfusion of a segment of the pancreatic body (Fig. 3).
Patient 1. Preoperative CT. Compression of the pancreas (large arrow) and the coeliac trunk (arrow) from a massively dilated stomach.
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The preoperative CT scan was reinvestigated and revealed extensive compression by the extended and undrained stomach affecting the pancreas and the coeliac trunk (Fig. 4).
Patient 1. After final stent removal the anastomosis was intact and open.
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A forth stent (Endoflex) was necessary until day 103 for complete healing of the anastomosis (Fig. 5).
Patient 2 prior to surgery. Free air around the perforated stomach encircled by the peritoneum.
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Repeat CT showed free air around the herniated stomach and fluid in the abdomen (Fig. 6).