T-fastener gastropexy and percutaneous gastrostomy under CT-fluoroscopic guidance in a patient with partial gastrectomy

The real-time images of computed tomography (CT)-fluoroscopy provide an excellent means of guidance for percutaneous interventions. We describe the performance of T-fastener gastropexy and percutaneous gastrostomy under CT-fluoroscopic guidance in a 59-year-old woman who had received total pharyngolaryngectomy for hypopharyngeal cancer and partial gastrectomy with Billroth II anastomosis for bleeding gastric ulcer 10 years before this operation. The previous gastric operation altered the gastrointestinal anatomy and made conventional fluoroscopic-guided percutaneous gastrostomy extremely difficult and risky. The T-fastener gastropexy and percutaneous gastrostomy were accomplished smoothly in a single session using CT-fluoroscopic guidance. This modified method of percutaneous gastrostomy may be useful in patients with anatomic distortion due to previous gastric surgery.