title: Computed tomographic scan mapping of gastric wall perfusion and clinical implications.
abstract: BACKGROUND
  Several postoperative gastrointestinal complications are attributed to ischemia. We herein evaluate the gastric wall perfusion using computed tomography (CT) scan perfusion index on trial to address the etiology of ischemic complication after sleeve gastrectomy.
  
  
  METHODS
  A retrospective study of 205 patients undergoing CT scan of the abdomen to evaluate the pattern of gastric vascular perfusion was performed. The perfusion index of the gastric mucosa was measured at 5 gastric points using CT perfusion scanning.
  
  
  RESULTS
  Gastric perfusion at the angle of His (AOH) (53.51 ± 14.38) was statistically significantly lower (P < .001) than that at the other gastric points studied: fundus, greater curvature, lesser curvature, incisura angularis, and mid gastric points (76.16 ± 15.21, 73.27 ± 16.55, 76.12 ± 16.12, and 75.24 ± 14.9, respectively). Gastric perfusion was significantly lower at all the gastric points (and especially so at the AOH) among obese patients (33 cases) compared with nonobese patients (18 cases). Gastric perfusion at all the points studied showed a decrease as the body mass index increases. Hypertensive patients had a better gastric perfusion compared with nonhypertensive patients.
  
  
  CONCLUSIONS
  Gastric wall perfusion is statistically significantly decreased at the AOH and gastric fundus compared with perfusion at other gastric points. Gastric perfusion at all the gastric points studied decreased with the increase in body mass index. Gastric leakage in obese patients following sleeve gastrectomy could be attributed to a decrease in the blood supply at AOH.
authors.affiliation: Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA. Electronic address: saber6231@gmail.com.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Saber
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA.
authors.forename: Nami
authors.initials: N
authors.lastname: Azar
authors.affiliation: Department of Radiology, The Brooklyn Hospital Center, Weill Cornel Medical College, New York, NY, USA.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Dekal
authors.affiliation: Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA.
authors.forename: Tamer N
authors.initials: TN
authors.lastname: Abdelbaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods; D005753:Gastric Mucosa / Q000098:blood supply* / Q000000981:diagnostic imaging; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Gastric perfusion; Leaks; Sleeve leak