Does contrast pass from the stomach to the small intestines after a gastrojejunostomy?

Contrast Passage After Gastrojejunostomy

Yes, contrast does pass from the stomach to the small intestines after a gastrojejunostomy, as this is the primary purpose of the surgical anastomosis. 1

Contrast Flow in Gastrojejunostomy Patients

Gastrojejunostomy creates a direct connection between the stomach and jejunum, allowing contents (including contrast media) to bypass the duodenum and flow directly into the small intestine. This surgical anastomosis is specifically designed to ensure passage of gastric contents into the small bowel.

Contrast Studies in Gastrojejunostomy Patients

Water-soluble contrast agents like Gastrografin (diatrizoate meglumine and diatrizoate sodium) are commonly used to evaluate the patency of gastrojejunal anastomoses 2:

• The contrast medium is administered orally or via nasogastric tube (50-150 ml)
• Fluoroscopic guidance allows real-time visualization of contrast flow through the anastomosis
• Follow-up radiographs can be taken to confirm passage into the small bowel

Clinical Applications of Contrast Studies

Evaluation of Anastomotic Patency

Contrast studies are valuable for assessing potential complications after gastrojejunostomy:

• Anastomotic stricture or stenosis: Contrast will show narrowing or complete obstruction at the anastomotic site 3
• Anastomotic leak: Contrast extravasation outside the GI tract indicates a leak
• Delayed emptying: Slow passage of contrast through the anastomosis

Diagnostic Protocol

When evaluating gastrojejunostomy patency:

1. Administer water-soluble contrast (Gastrografin) orally or via tube
2. Obtain initial images to visualize the anastomosis
3. Take delayed images (typically at 30 minutes and 4 hours) to assess passage into small bowel 4
4. If contrast reaches the colon within expected timeframe, patency is confirmed

Important Considerations

Technical Aspects

Fluoroscopy-guided contrast studies offer several advantages when evaluating gastrojejunostomy:

• Real-time visualization of contrast flow through the anastomosis
• Ability to position the patient to optimize visualization
• Can detect functional issues like delayed emptying that static images might miss 1

Potential Complications

When performing contrast studies after gastrojejunostomy:

• Aspiration risk: Ensure proper positioning and consider nasogastric administration if aspiration risk is high
• Dehydration: Water-soluble contrast agents have high osmolarity and can shift fluids into the bowel lumen 1
• Allergic reactions: Though rare, anaphylactoid reactions to oral contrast media have been reported 1

Clinical Pearls

• In post-operative patients, selective rather than routine upper GI contrast studies may be preferred to reduce hospital stay while maintaining safety 5
• If obstruction is suspected, contrast that fails to pass into the small bowel within 4 hours suggests mechanical obstruction requiring surgical intervention 4
• For patients with altered anatomy after gastrojejunostomy, fluoroscopic guidance is essential for proper evaluation of the anastomosis 1

In summary, contrast does pass from the stomach to the small intestines after gastrojejunostomy, and contrast studies are valuable tools for evaluating anastomotic patency and detecting potential complications.