2 nd Jogjakarta Digestive Week

Radiology play role to

prevention and reduce
surgery complication
Bambang P Utomo
How radiologist prevention
and reduce surgery
complication?
 Need contribution from
surgeon to:

• Ordering proper radiology modalities test based

on suspected diagnoses from reasonable
differential diagnosis

• Well informed the radiologist about the case to

make strategy to visualized the disease
 Threat to diagnostic imaging
• Omission of needed test

• Incorrect test

• Incomplete information

• incomplete examination

• Improper performed test

• Incorrect interpretation/ pitfall

• Misleading radiologist report

 Radiology modalities
in digestif surgery
• Radiography
• Contras examination
• Ultrasonography
• Computerized Tomography Scan
• Magnetic Resonance Imaging
• Nuclear imaging
• Positron Emision Tomography Scan
• Chateterization
 How to choose it?

• What to be investigated?

• Firm case, spesific modality

• Open differential diagnosis, choose sensitive

modality for all

• Complement and confirmation radiology

examination.
 Evidence base modalities radiology
in digestif surgery
• Radiography : Bowel obstruction, free air, free fluid, opaque or huge
mass

• Contras examination : Hollow viscus lumen, mucosal pattern, landmark.

• Ultrasonography : Solid, cystic mass and vascular

• CT Scan : TNM, topography, compartment and vascular

• MRI : Softisue differentiated, hepatobillier imaging and vascular

• Pet Scan : Tracking primer or metastase malignancy disease

• Chateterisation : Feeding artery tumor, trans arterial embolisation/

chemo infusion
 What radiology can do?
• 1. Located the lesion, intra/ retroperitoneal or in the spesific
organ

• 2. Measuarement and the extension the lesion

• 3. Approaching the pathological anatomy of the lesion

• 4. Determine the malignancy and staging the disease

• 5. Search as result and consequences of the lesion

• 6. Grading the severity of the disease

• 7. Determine resectabilities the lesion

 At least

How surgeon interpret the radiologist's report?,

requires familiarity with relevant terminology imaging
finding
 The Cases

• Proved cases

• Discussed cases

• Ilustrations
1. Located the lesion

retroperitoneal
mass

intraperitoneal
mass

proved case
To located the lesion

retroperitoneal
mass

proved case
To located the lesion
Teratoma retroperitoneal

proved case
 2. Measurement and
the extension the lesion
Dysphagia

• Distal lesion?

• Partial or severe obstruction?

• Achalasia or mass?

• From esophagus or gaster?

• The lenght of lesion

• TNM, resectabilitas?
 Dysphagia

Achalasia Esophagus mass Gastric mass

proved case
 Carcinoma

At least

proved case
3. Approaching PA of the lesion
3. Approaching PA of the lesion

FNH Cavernous hemangioma

proved case & Ilustration

3. Approaching PA of the lesion Early
hypo lesion
HCC
Adenoma

Arteri phase

Venous phase

Late phase

proved case & Ilustration

3. Approaching PA of the lesion
Klatskin tumor

Arteri phase Venous phase

proved case
4. Determine the malignancy &
staging
Gastric cancer T2

Ilustration case
4. Determine the malignancy &
staging
Gastric cancer T3

Ilustration case
4. Determine the malignancy &
staging

Gastric cancer T4A

Ilustration case
4. Determine the malignancy &
staging
HCC, lnn & metastase

Proved case
 5. Search as result &
consequences of the lesion

Lymfoma

Artery phase Venous phase

Proved case
6. Grading severity

nineteen days later

Acute necrotizing pancreatitis, mild Late necrotizing pancreatitis, with local

severity walled-off of post necrotizing

Proved Case
6. Grading severity Gas forming abcess
Abcess

Proved & Illustration Case

7. Resectability

No vasculair incasement

Proved Case
7. Resectability

vasculair incasement

Proved Case
Micelaneus case
Large bowel mass

Radiologist’s report : Small Bowel Obstruction

Post op : Mass in lienalis flexure
Full Fill Fluid

Proved Case
 AMS Syndrom

Radiologist’s report : —-
Post op : Arteria Mesenterica
Superior Syndrom
proved case Full Fill Fluid
 ……… Ileus ? Discussed case

Radiologist’s report :
Post op : ——
Full Fill Fluid
Equivocal CBD stone on CT, obvious on
Ultrasound, clear on on MRI

•• Dysphagia

Proved Case
 Hollow viscus trauma

Proved Case
Hollow viscus trauma

Proved Case
Great Momentum

Mass

Infarction

Strangulation

Proved & Ilustration Case F.Jausset et al 2014

 Suatu kehormatan bisa
berada di tengah tengah
keluarga besar bedah digestif