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Original Report
Studying the complications of bariatric surgery with intravenous contrast-enhanced multidetector computed tomography
Estudio de las complicaciones de la cirugía bariátrica por tomografía computarizada multidetector con contraste intravenoso
C. Morandeiraa,
Corresponding author
morandeiraclara@gmail.com

Corresponding author.
, M.V. Bárcenaa, A. Bilbaob, M. Péreza, A.M. Ibáñeza, M. Isusia, G. Lecumberria
a Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Spain
b Unidad de investigación, Hospital Universitario Basurto, Bilbao, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Obesity is a chronic condition defined<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> as a body mass index &#40;BMI&#41; over 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; It is considered a worldwide epidemic&#44; and in Spain it affects 16&#46;9&#37; of the population over 18&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#8211;3</span></a> Today&#44; there is an important increase of bariatric surgeries due to the higher incidence rate of this condition&#44; the lack of conservative treatment&#44; and the improved results coming from the surgical procedures&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> that not only achieve weight reductions&#44; but also help maintain these drops&#44; and reduce the associated comorbidity&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4&#8211;6</span></a> At our hospital&#44; after positive assessment by the units of endocrinology and psychiatry&#44; the unit of general surgery completes the surgical indication based on the patient&#39;s characteristics&#44; such as the BMI&#44; any associated comorbidities&#44; the symptomatic abdominal surgical pathology&#44; and the clinical repercussion on the quality of life of obesity&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although complications due to bariatric surgery are growing thin&#44;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5&#44;7</span></a> patients need one multidisciplinary approach where radiologists play a fundamental role in the detection of complications&#44; particularly thanks to the increased availability of the intravenous contrast-enhanced multidetector computed tomography &#40;IVCE-MDCT&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#8211;11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Our goal is to review the postoperative complications of bariatric surgery and their diagnosis using the IVCE-MDCT&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">One retrospective study of all the patients operated of bariatric surgery was conducted at our center&#46; This review was approved by our hospital clinical research ethics committee&#46; All patients operated through gastric bypass procedure &#40;GBP&#41;&#44; or sleeve gastrectomy &#40;SG&#41; procedure for the management of their morbid obesity from January 2013 through December 2014 were included in the study&#46; Both the clinical histories &#40;sociodemographic variables&#44; and clinical evolution&#41;&#44; and the radiologic imaging modalities conducted in these patients until December 2015 were reviewed&#44; being the major abdominal complications derived from the radiologic diagnosis assessed and categorized into early &#40;within the first month after the intervention&#41;&#44; and late complications &#40;within the second month after the intervention&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Both the IVCE-MDCT and the barium swallow study &#40;BS&#41; were considered diagnostic methods&#46; Whenever the complication was acute&#44; or the patient was hemodynamically unstable&#44; the IVCE-MDCT was conducted&#46; The BSs were reserved for chronic complications and cases with non-diagnostic IVCE-MDCT&#46; Also&#44; through the first half of the year 2013&#44; scheduled BSs were conducted in all patients within the first 48<span class="elsevierStyleHsp" style=""></span>h after the surgical procedure&#44; in order to rule out dehiscence of sutures&#44; and confirm correct bowel transits&#46; The IVCE-MDCTs were conducted using one Siemens Somaton Emotion machine&#44; and the images were reconstructed with 2&#46;5<span class="elsevierStyleHsp" style=""></span>mm slices&#46; Eighty ml of intravenous contrast &#40;IVC&#41; were administered <span class="elsevierStyleItalic">Iomeron 300</span> &#40;lomeprol 1<span class="elsevierStyleHsp" style=""></span>g&#47;100<span class="elsevierStyleHsp" style=""></span>ml&#41; at a flow rate of 2<span class="elsevierStyleHsp" style=""></span>ml&#47;s&#44; and a 60 second-delay&#46; On suspicion of bleeding&#44; triphasic studies were indicated&#44; conducting one arterial phase with 120<span class="elsevierStyleHsp" style=""></span>ml of IVC at a flow rate of 4<span class="elsevierStyleHsp" style=""></span>ml&#47;s&#46; On suspicion of dehiscence of sutures or perforation&#44; a series with oral contrast of Gastrolux was added &#40;meglumine amidotrizoate&#44; and sodium amidotrizoate 3&#46;7<span class="elsevierStyleHsp" style=""></span>g&#47;100<span class="elsevierStyleHsp" style=""></span>ml&#41; at a 5&#47;100 dilution&#46; All studies were reviewed by four &#40;4&#41; expert radiologists included in the authorship of the paper&#44; three of them with over 20 years of experience in abdominal radiology&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">One hundred and fifty-five &#40;155&#41; cases were reviewed&#46; The sociodemographic variables are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; There were 24 complications in 22 patients&#46; The complications and their radiologic findings are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; On the one hand&#44; sixteen &#40;16&#41; complications occurred within the first month after the procedure&#46; Seven &#40;7&#41; intraperitoneal hemorrhages &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; two &#40;2&#41; dehiscences of sutures &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; two &#40;2&#41; bowel obstructions &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; and two &#40;2&#41; hernias of the abdominal wall &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41; were diagnosed&#46; On the other hand&#44; there were eight &#40;8&#41; complications within the second month after the surgical procedure&#58; three &#40;3&#41; internal hernias &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#44; three &#40;3&#41; bowel perforations&#44; and two &#40;2&#41; ulcers of the gastric mucosa adjacent to the surgical sutures &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; The complications were managed through surgical procedures in 15 patients&#44; and conservative treatment in 9 patients&#46; Yet despite of all this&#44; 2 patients &#40;1&#46;3&#37;&#41; died during the postoperative period&#46; The first patient underwent one SG procedure since the BMI was 78&#46;3<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; The patient had low blood pressure levels three &#40;3&#41; days after the surgical procedure&#44; and the IVCE-MDCT confirmed presence of a large-volume hemoperitoneum&#46; The patient was surgically operated but died during the postoperative period due to multiple organ failure&#46; The second patient underwent one SG procedure since the BMI was 71&#46;55<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; and six &#40;6&#41; days after the surgical procedure&#44; presented with abdominal pain&#44; and purulent fluid effusion from the abdominal drainage&#46; The IVCE-MDCT diagnosed dehiscence of sutures&#44; but the patient died due to septic shock&#44; yet despite the surgical procedure&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Among all the patients with complications&#44; 21 &#40;95&#46;5&#37;&#41; were diagnosed using the IVCE-MDCT&#44; and one &#40;4&#46;5&#37;&#41; needed a BS to achieve diagnosis&#46; It was one patient who&#44; one year after being operated through one GBP for having a BMI of 40&#46;7<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; started having problems of dysphagia&#46; The IVCE-MDCT conducted turned out normal&#44; and the BS confirmed the presence of stenosis of the gastroduodenal anastomosis with one perianastomotic ulceration&#46; Also&#44; in the group of uncomplicated patients&#44; IVCE-MDCTs were conducted on 23 patients &#40;52&#46;27&#37; of all the IVCE-MDCTs conducted&#41; on suspicion of complications&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Three &#40;3&#41; surgical procedures were identified&#46; In the first place&#44; 66&#37; of the patients underwent one GBP&#44; which is the technique of choice and consists of dividing the stomach using staples into one 15&#8211;35<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>-fundic pouch and one excluded stomach&#46; After this&#44; one jejunal loop is cut off at 25&#8211;50<span class="elsevierStyleHsp" style=""></span>cm from the ligament of Treitz&#44; and its distal edge is anastomosed with the gastric remnant&#44; forming the alimentary limb in antecolic or retrocolic location with respect to the transverse colon&#46; Finally&#44; the proximal edge of the cut off jejunal loop is anastomosed with one small bowel loop at 75&#8211;150<span class="elsevierStyleHsp" style=""></span>cm from the gastrojejunostomy procedure&#46; This is the way to one combined technique both restrictive and malabsorptive<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;8&#8211;12</span></a> with good results in weight reduction and improved associated comorbidity&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;11&#8211;14</span></a> Secondly&#44; almost 31&#37; of the patients underwent one SG procedure indicated both in superobese &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>55<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and patients at high surgical risk&#44; or pathology requiring endoscopic controls&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;5</span></a> This procedure consists of dividing the stomach by performing the resection of one part of the gastric cavity along the greater curvature&#46; This is one restrictive technique only&#44;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;5&#44;9&#8211;11</span></a> with worse clinical outcomes because there are more chances of weight gain due to the progressive dilatation of the stomach&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> Thirdly&#44; five &#40;5&#41; patients underwent one surgical reconversion&#44; that is&#44; first the SG procedure was conducted&#44; and after achieving an adequate reduction of the BMI and the associated comorbidity&#44; the treatment was completed conducting one GBP&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Most were early complications&#46; The intraperitoneal bleeding was the most common of all and the one that killed the patient&#46; Other studies show a similar incidence rate&#44; between 0&#46;6 and 4&#37;&#46; These patients require surgical management when they are hemodynamic unstable&#44; being the gastrojejunostomy procedure the most common bleeding site during the GBP&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;2&#44;6</span></a> The second early most common complication was the dehiscence of sutures that also led to the patient&#39;s death&#46; Other series show incidence rates of complications around 6&#37; during the GBP&#8211;slightly higher in the SG procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> In these cases&#44; the clinical manifestations may be unspecific and progress rapidly to sepsis&#44; requiring the unstable patients surgical reintervention&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;6&#44;15</span></a> In the GBP&#44; the most common location is the gastrojejunal anastomosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;5&#44;7</span></a> Only two &#40;2&#41; early obstructions were diagnosed&#44; yet it is the most common complication in other series published&#46; The main cause is the presence of edema&#44; or hematoma in the anastomosis&#46; During the GBP&#44; the obstruction site is usually found in the gastrojejunostomy procedure&#44; particularly in patients with antecolic reconstruction of the alimentary limb&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;5&#44;7&#44;11</span></a> Finally&#44; there were two &#40;2&#41; external hernias&#46; The incidence rate was low due to a greater tendency to perform laparoscopic approaches&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">At the beginning of the second month&#44; eight &#40;8&#41; complications occurred&#46; Three &#40;3&#41; internal hernias occurred in patients operated through GBP&#44; defined as the herniation of bowel loops through a solution of internal continuity that&#44; in these patients&#44; is secondary to surgical procedures&#44; showing laxity due to rapid weight loss&#46; The incidence rate of our series is lower than that of other studies published so far&#44; even though the risk is higher as the number of laparoscopic procedures increases&#44; since there are fewer adhesions&#44;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;2&#44;4&#44;6&#44;8&#44;11&#44;12&#44;15&#8211;20</span></a> and they are more common in the GBP with retrocolic reconstruction because of the need to make one orifice caudal to the transverse colon&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> Complications can be transmesocolic &#40;when the loops become herniated through a defect in the transverse mesocolon&#41;&#59; transmesenteric &#40;when the solution of continuity is in the small bowel mesentery through jejunojejunostomy procedure&#41;&#44; or Petersen hernias &#40;the herniated loops occupy the Petersen&#39;s space created between the jejunal mesentery of the alimentary limb and the transverse mesocolon&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#8211;19</span></a> The clinical manifestations are chronic and sporadic&#44; although they can cause acute complications&#44; such as obstructions&#44; or bowel ischemia&#44; and require surgical treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4&#44;11&#8211;13&#44;16&#8211;20</span></a> Also&#44; there are other causes of late obstructions such as postoperative flanges&#44; invaginations&#44; or bezoars&#44; that our patients did not show&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;10</span></a> Other late complications were bowel perforations&#44; and ulcers in the surgical scar&#44; they were due to poor dietetic control&#44; and had a similar incidence rate to that reported by other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In our series we did not take into account minor complications such as cholelithiasis&#44; or gastroesophageal reflux&#59; complications from non-radiologic diagnoses &#40;dumping syndrome&#44; or gastritis&#41;&#59; or non-abdominal complications&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> We did not objectivize either certain major abdominal complications from radiologic diagnoses described in other series&#44; such as splenic and hepatic infarctions<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a>&#59; or bowel ischemias&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The complications are non-specific of the surgical procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> However&#44; some studies say that these complications are more common in patients operated through GBP&#44; although no differences in the life-threatening risks have ever been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;5&#44;14</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The IVCE-MDCT is the first imaging modality of choice in the diagnosis of major complications due to bariatric surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;12&#44;20</span></a> When hemorrhages are suspected&#44; it allows us to diagnose and locate them&#44; and assess whether or not there is active bleeding&#46; In the presence of dehiscence of sutures&#44; or perforation&#44; the presence of pneumoperitoneum and free fluid is characteristic&#46; Also&#44; the administration of oral contrast in these patients is recommended in order to identify the site of the leakage&#46; In patients operated through GBP&#44; the presence of oral contrast in the excluded stomach is usually secondary to reflux&#44; and should not be mixed up with collections&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;8&#44;11&#44;20</span></a> When an obstruction is suspected&#44; the IVCE-MDCT shows the bowel loops damaged&#44; rules out any associated complications&#44; and identifies the obstruction site&#46; When it comes to hernias&#44; the IVCE-MDCT also allows us to exclude the presence of any additional complications&#46; In the diagnosis of internal hernias&#44; although the IVCE-MDCT is the preferred imaging modality&#44; the radiologic findings are not sensitive nor specific&#44; so when suspicion is high&#44; these hernias should be managed surgically even if the IVCE-MDCT looks normal&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;6&#44;11&#44;16&#44;18&#8211;20</span></a> The most specific finding in these patients is the twisted mesenteric vessels associated to bowel obstructions&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4&#44;18</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In the study there is a significant amount of radiologic imaging modalities conducted in uncomplicated patients&#46; Most were BS procedures scheduled during the first surgical procedures in order to confirm the presence of a correct transit&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;20</span></a> Afterwards&#44; the guidelines rejected the indication of this imaging modality and postoperative IVCE-MDCTs in asymptomatic patients due to their scarce sensitivity rate&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> This is why radiologic imaging modalities should only be conducted when on suspicion of complications&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The limitations of this study are its retrospective nature&#44; and the fact that it was limited to one single hospital only&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In sum&#44; bariatric surgery is an increasingly popular surgical procedure&#44; yet despite the fact that the rate of complications is high&#44; and the rate of mortality is not negligible&#46; It is essential to know what these patients&#8217; normal findings look like to be able to identify any possible complications&#44; most of them diagnosed using the IVCE-MDCT&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Authors</span><p id="par0085" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study&#58; CM and MB&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Study Idea&#58; CM and MB&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Study Design&#58; MB&#44; MP and AI&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Data Mining&#58; CM and MB&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Data Analysis and Interpretation&#58; CM and AB&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Statistical Analysis&#58; AB&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Reference&#58; CM&#44; MB&#44; GL and MI&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Writing&#58; CM and MB&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks&#58; CM&#44; MB&#44; AB&#44; MP&#44; AI&#44; MI and GL&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Approval of final version&#58; CM&#44; MB&#44; AB&#44; AI&#44; MP&#44; MI and GL&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests associated with this article whatsoever&#46;</p></span></span>"
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    "fechaRecibido" => "2017-02-21"
    "fechaAceptado" => "2017-12-12"
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          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Bariatric surgery"
            1 => "Postoperative complications"
            2 => "Multidetector computed tomography"
            3 => "Contrast agent"
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          "palabras" => array:4 [
            0 => "Cirug&#237;a bari&#225;trica"
            1 => "Complicaciones posoperatorias"
            2 => "Tomograf&#237;a computarizada multidetector"
            3 => "Contraste"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To review the complications of bariatric surgery and their diagnosis with intravenous contrast-enhanced multidetector computed tomography &#40;MDCT&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We retrospectively studied all patients who underwent gastric bypass or sleeve gastrectomy at our center during 2013 or 2014&#46; We classified complications into early complications &#40;appearing within 30 days of the intervention&#41; and late complications&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We reviewed 155 cases and found 24 complications in 22 patients&#58; 16 early complications &#40;7 intraperitoneal hematomas&#44; 5 anastomotic dehiscences&#44; 2 intestinal obstructions&#44; and 2 external hernias&#41; and 8 late complications &#40;3 internal hernias&#44; 3 intestinal perforations&#44; and 2 marginal ulcers&#41;&#46; Two patients died&#46; All of these complications were diagnosed with intravenous contrast-enhanced MDCT&#44; except one&#44; which required a barium transit study&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The rate of complications in bariatric surgery is high and the associated mortality is not negligible&#46; Radiologists need to know the normal findings in these patients so they can quickly identify possible complications&#44; most of which can be diagnosed with intravenous contrast-enhanced MDCT&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Revisar las complicaciones de la cirug&#237;a bari&#225;trica y su diagn&#243;stico mediante tomograf&#237;a computarizada multidetector con contraste intravenoso &#40;TCMDcCIV&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de los pacientes intervenidos mediante <span class="elsevierStyleItalic">by-pass</span> g&#225;strico o gastrectom&#237;a tubular en nuestro centro durante 2013 y 2014&#46; Las complicaciones se dividieron en precoces &#40;durante el primer mes&#41; y tard&#237;as&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se revisaron 155 casos y se diagnosticaron 24 complicaciones en 22 pacientes&#58; 16 precoces &#40;7 hematomas intraperitoneales&#44; 5 dehiscencias anastom&#243;ticas&#44; 2 obstrucciones intestinales y 2 hernias externas&#41; y 8 tard&#237;as &#40;3 hernias internas&#44; 3 perforaciones intestinales y 2 &#250;lceras en boca anastom&#243;tica&#41;&#46; Dos pacientes fallecieron&#46; Todas las complicaciones se diagnosticaron mediante TCMDcCIV&#44; excepto una que requiri&#243; un tr&#225;nsito baritado&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La tasa de complicaciones en la cirug&#237;a bari&#225;trica es elevada y su mortalidad no es despreciable&#46; Deben reconocerse los hallazgos normales en estos pacientes para identificar r&#225;pidamente las posibles complicaciones&#44; diagnosticadas en su mayor&#237;a mediante TCMDcCIV&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Morandeira C&#44; B&#225;rcena MV&#44; Bilbao A&#44; P&#233;rez M&#44; Ib&#225;&#241;ez AM&#44; Isusi M&#44; et al&#46; Estudio de las complicaciones de la cirug&#237;a bari&#225;trica por tomograf&#237;a computarizada multidetector con contraste intravenoso&#46; Radiolog&#237;a&#46; 2018&#59;60&#58;143&#8211;151&#46;</p>"
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            "Ancho" => 1662
            "Tamanyo" => 338129
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hematoma at the foot of the loop in a patient operated through GBP&#46; &#40;A&#41; MDCT on the axial plane without IVC showing one hyperdense collection &#40;47<span class="elsevierStyleHsp" style=""></span>HU&#41; adjacent to the gastrojejunostomy procedure &#40;asterisk&#41;&#46; &#40;B&#41; IVCE-MDCT on the axial plane in the venous phase not showing contrast extravasation &#40;48<span class="elsevierStyleHsp" style=""></span>HU&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1830
            "Ancho" => 966
            "Tamanyo" => 205421
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Dehiscence of sutures in a patient operated through SG procedure&#46; &#40;A&#41; IVCE-MDCT on the axial plane showing perisplenic free fluid &#40;black asterisk&#41;&#44; and one perihepatic collection &#40;white asterisk&#41;&#46; &#40;B&#41; IVCE-MDCT on the coronal plane after the administration of oral contrast showing the leakage of contrast medium through the gastrectomy line toward the left subphrenic space &#40;arrow&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2006
            "Ancho" => 969
            "Tamanyo" => 188907
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Bowel obstruction 13 days after undergoing one GBP&#46; &#40;A&#41; IVCE-MDCT on the paracoronal plane showing one dilated alimentary limb &#40;arrows&#41; formed by jejunum from the proximal gastrojejunal anastomosis &#40;white asterisk&#41; toward the distal jejunojejunal anastomosis &#40;asterisk&#41; without identification of the underlying cause&#46; &#40;B&#41; IVCE-MDCT on the sagittal plane showing one dilated jejunal alimentary limb in the anterior position &#40;arrows&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1865
            "Ancho" => 962
            "Tamanyo" => 172507
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Eventration of bowel through the trocar orifice in a patient operated through GBP&#46; &#40;A&#41; MDCT on the sagittal plane with IVC showing the herniation of one small bowel loop running through the abdominal wall and following the trajectory of the surgical trocar &#40;arrow&#41;&#46; &#40;B&#41; MDCT on the axial plane with IVC showing the anterograde bowel obstruction determined by it &#40;white asterisk&#41;&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1423
            "Ancho" => 1512
            "Tamanyo" => 256646
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Internal hernia in a patient operated through GBP&#46; &#40;A&#41; IVCE-MDCT on the axial plane showing dilated small bowel loops located in the left upper quadrant &#40;arrows&#41; and adjacent to the proximal gastrojejunal anastomosis &#40;asterisk&#41;&#46; &#40;B&#41; IVCE-MDCT on the coronal plane showing dilated bowel loops in a cephalic position with respect to the transverse colon &#40;asterisk&#41;&#46; &#40;C&#41; IVCE-MDCT on the axial plane showing lateralization toward the right side of the distal jejunojejunal anastomosis &#40;asterisk&#41;&#46; &#40;D&#41; IVCE-MDCT on the sagittal plane showing twisted mesenteric vessels &#40;circle&#41; accompanied by bowel obstruction in another patient with an internal hernia&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 2560
            "Ancho" => 962
            "Tamanyo" => 311108
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Ulcer adjacent to the proximal gastrojejunal anastomosis in a patient operated through GBP&#46; &#40;A&#41; Simple X-ray with oral contrast conducted in a BS showing a reduced caliber of the gastrojejunal anastomosis and an image of the addition of contrast in relation to an ulcer &#40;asterisk&#41;&#46; &#40;B&#41; IVCE-MDCT on the axial plane showing increased fat density adjacent to the surgical clip &#40;asterisk&#41; in another patient operated through GBP in relation to an ulcer adjacent to the proximal gastrojejunal anastomosis&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; GBP&#58; gastric bypass procedure&#59; SG&#58; sleeve gastrectomy procedure&#59; BMI&#58; body mass index&#59; R&#58; reconversion&#59; TC&#58; computed tomography scan&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The data are expressed as frequencies &#40;row percentages&#41;&#44; or averages &#40;standard deviation&#41;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients with complications<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients without complications<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>133&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Sex&#44; n &#40;&#37;&#41;</span></td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0098&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36 &#40;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>107&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97 &#40;90&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; average &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#46;6 &#40;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;6 &#40;10&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0960&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Weight&#44; average &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139 &#40;33&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129&#46;8 &#40;25&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2360&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BMI&#44; average &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;6 &#40;11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;4 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1887&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Surgical technique&#44; n &#40;&#37;&#41;</span></td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6744&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>GBP &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>102&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;14&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;85&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SG &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;87&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>R &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Diagnostic method&#44; n &#40;&#37;&#41;</span></td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CT scan &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;47&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;52&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;95&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>None &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1704397.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Complications based on the demographic characteristics&#44; surgical technique used&#44; and diagnostic method &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>155&#41;&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Radiologic findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Management&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Early &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Intraperitoneal hemorrhage&#47;edema &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hyperdense collection &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;<br>Hemoperitoneum &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;<br>Extravasation of contrast if there is active bleeding &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conservative &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;<br>Surgical drainage in the presence of hemodynamic instability &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dehiscence of suture &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pneumoperitoneum &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;<br>Free fluid &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;<br>Effusion of oral contrast in the surgical anastomosis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Surgical closure &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bowel obstruction &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dilatation of the digestive tract until the obstruction site &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conservative &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">External hernia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eventration of bowel loops and mesenteric fat &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Herniorrhaphy &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Late &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Internal hernia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Altered disposition of loops and anastomosis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;<br>Twisted mesenteric vessels &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;<br>Dilated bowel loops &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Surgical reduction of the hernia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bowel perforation &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pneumoperitoneum &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;<br>Free fluid &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;<br>Effusion of oral contrast distant to the surgical anastomosis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conservative&#44; if the perforation is contained &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;<br>Surgical closure &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ulcer of the anastomotic mouth &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reticular pattern of mesenteric fat &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;<br>Image of the administration of oral contrast &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conservative &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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ISSN: 21735107
Original language: English
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