Upper Abdomen

Dissection – Demonstration of the fistulous tract (Courtesy Dr. V. Penopoulos)

Dissection – Demonstration of the fistulous tract (Courtesy Dr. V. Penopoulos)

Dissection – Demonstration of the fistulous tract (Courtesy Dr. V. Penopoulos)

Dissection – Demonstration of the fistulous tract (Courtesy Dr. V. Penopoulos)

Gastroscopy. Green arrows: orifice of the gastrocolic fistula (Courtesy Dr. V. Penopoulos)

Lateral view. Red arrows: gastrocolic fistula (Courtesy Dr. V. Penopoulos)

Repeat abdominal CT scan demonstrating complete resorption and disappearance of air from the stomach and the portal venous system (Courtesy Dr. V. Penopoulos)

Repeat abdominal CT scan demonstrating complete resorption and disappearance of air from the stomach and the portal venous system (Courtesy Dr. V. Penopoulos)

Gastroscopy. Gastric emphysema (Courtesy Dr. V. Penopoulos)

Air in the portal venous system (Courtesy Dr. V. Penopoulos)

Air in the gastric wall (Courtesy Dr. V. Penopoulos)

Electron micrograph demonstrating the SIP syncytium in the guinea pig stomach. Panel A, Mitsui & Komuro. Cell Tissue Res 2002;309:219-227; Panel B-D, Sung TS, et al. J Physiol 2018;596:1549-1574; Panel E, Sanders KM et al. J Physiol 2010;588:4621-4639 (Courtesy Dr. V. Penopoulos)

Gastrointestinal motility disorders in neurological diseases. J Clin Invest 2021;131:e143771 (Courtesy Dr. V. Penopoulos)

Extrinsic innervation of the stomach (Courtesy Dr. V. Penopoulos)

Electron micrograph demonstrating the SIP syncytium in the guinea pig stomach. Panel A, Mitsui & Komuro. Cell Tissue Res 2002;309:219-227; Panel B-D, Sung TS, et al. J Physiol 2018;596:1549-1574; Panel E, Sanders KM et al. J Physiol 2010;588:4621-4639 (Courtesy Dr. V. Penopoulos)

Electron micrograph demonstrating the SIP syncytium in the guinea pig stomach. Panel A, Mitsui & Komuro. Cell Tissue Res 2002;309:219-227; Panel B-D, Sung TS, et al. J Physiol 2018;596:1549-1574; Panel E, Sanders KM et al. J Physiol 2010;588:4621-4639 (Courtesy Dr. V. Penopoulos)

Electron micrograph demonstrating the SIP syncytium in the guinea pig stomach. Panel A, Mitsui & Komuro. Cell Tissue Res 2002;309:219-227; Panel B-D, Sung TS, et al. J Physiol 2018;596:1549-1574; Panel E, Sanders KM et al. J Physiol 2010;588:4621-4639 (Courtesy Dr. V. Penopoulos)

Electron micrograph demonstrating the SIP syncytium in the guinea pig stomach. Panel A, Mitsui & Komuro. Cell Tissue Res 2002;309:219-227; Panel B-D, Sung TS, et al. J Physiol 2018;596:1549-1574; Panel E, Sanders KM et al. J Physiol 2010;588:4621-4639 (Courtesy Dr. V. Penopoulos)

Subtotal gastrectomy specimen (Courtesy Dr. V. Penopoulos)

Abdominal computed tomography. Atonic, distended stomach, filled with food residue (Courtesy Dr. V. Penopoulos)

Postoperative barium esophagography. Smooth passage of contrast through the myotomy site (Courtesy Dr. V. Penopoulos)

Nissen fundoplication (Courtesy Dr. V. Penopoulos)

Long anterior Heller myotomy (Courtesy Dr. V. Penopoulos)

Separation of the esophagus from the hiatal hernia (Courtesy Dr. V. Penopoulos)

Hiatal hernia cavity and complete closure/repair without mesh (Courtesy Dr. V. Penopoulos)

Cholecystectomy specimen (Courtesy Dr. V. Penopoulos)

Hiatal hernia defect. Green arrow - Right lung (Courtesy Dr. V. Penopoulos)

Barium esophagography. Esophageal achalasia (Courtesy Dr. V. Penopoulos)

Immunohistochemical staining with anti-CD117 antibody – Positive expression in mast cells and negative expression in elongated spindle cells (Courtesy Dr. V. Penopoulos)

Immunohistochemical staining with anti-CD117 antibody – Positive expression in mast cells and negative expression in elongated spindle cells (Courtesy Dr. V. Penopoulos)

Immunohistochemical staining with anti-CD117 antibody – Positive expression in mast cells and negative expression in elongated spindle cells (Courtesy Dr. V. Penopoulos)

Immunohistochemical staining with anti-CD117 antibody – Positive expression in mast cells and negative expression in elongated spindle cells (Courtesy Dr. V. Penopoulos)

Infiltration of the submucosal layer with granulation tissue (Courtesy Dr. V. Penopoulos)

Preservation of the mucosa is evident, with mildly hypertrophic appearance of the muscularis mucosae (Courtesy Dr. V. Penopoulos)

Inflammatory fibroid polyp of the duodenum (Courtesy Dr. V. Penopoulos)

Inflammatory fibroid polyp of the duodenum – Complete endoscopic removal of the IFP (Courtesy Dr. V. Penopoulos)

Abdominal CT scan. Red outline – Inflammatory fibroid polyp of the duodenum (Courtesy Dr. V. Penopoulos)

Yellow arrow — Thick-walled gallbladder with gallstones. Blue arrow — Stomach segment. Light blue arrows — Cholecystogastric fistula (Courtesy Dr. V. Penopoulos)

Yellow arrow — Thick-walled gallbladder with gallstones. Blue arrow — Stomach segment. Light blue arrows — Cholecystogastric fistula (Courtesy Dr. V. Penopoulos)

Yellow arrow — Thick-walled gallbladder with gallstones. Blue arrow — Stomach segment. Light blue arrows — Cholecystogastric fistula (Courtesy Dr. V. Penopoulos)

Gallstone in the ileum (Courtesy Dr. V. Penopoulos)

Plain abdominal radiographs. Small bowel loop distension. Red arrow — Radiopaque mass (gallstone) (Courtesy Dr. V. Penopoulos)

Completion Gastrectomy specimen (Courtesy Dr. V. Penopoulos)

Yellow arrow — Thick-walled gallbladder with gallstones. Blue arrow — Stomach segment. Light blue arrows — Cholecystogastric fistula (Courtesy Dr. V. Penopoulos)

Yellow arrow — Thick-walled gallbladder with gallstones. Blue arrow — Stomach segment. Light blue arrows — Cholecystogastric fistula (Courtesy Dr. V. Penopoulos)

Yellow arrow — Thick-walled gallbladder with gallstones. Blue arrow — Stomach segment. Light blue arrows — Cholecystogastric fistula (Courtesy Dr. V. Penopoulos)

Yellow arrow — Thick-walled gallbladder with gallstones. Blue arrow — Stomach segment. Light blue arrows — Cholecystogastric fistula (Courtesy Dr. V. Penopoulos)

Yellow arrow — Thick-walled gallbladder with gallstones. Blue arrow — Stomach segment. Light blue arrows — Cholecystogastric fistula (Courtesy Dr. V. Penopoulos)

Yellow arrow — Thick-walled gallbladder with gallstones. Blue arrow — Stomach segment. Light blue arrows — Cholecystogastric fistula (Courtesy Dr. V. Penopoulos)

The gastrocolic fistula (green arrow) (Courtesy Dr. V. Penopoulos)

Detail of the lesser curvature of the stomach. Early ischemic changes (Courtesy Dr. V. Penopoulos)

Organoaxial gastric volvulus (Courtesy Dr. V. Penopoulos)

Organoaxial gastric volvulus (Courtesy Dr. V. Penopoulos)

Organoaxial gastric volvulus (Courtesy Dr. V. Penopoulos)

Organoaxial gastric volvulus (Courtesy Dr. V. Penopoulos)

Organoaxial gastric volvulus (Courtesy Dr. V. Penopoulos)

Abdominal X-ray (Courtesy Dr. V. Penopoulos)

Chronic gastric volvulus (Courtesy Dr. V. Penopoulos)

A metastatic deposit on the excised gallbladder (Courtesy Dr. V. Penopoulos)

A metastatic deposit on the excised gallbladder (Courtesy Dr. V. Penopoulos)

A metastatic deposit on the excised gallbladder (Courtesy Dr. V. Penopoulos)

The excised gastric carcinoma (Courtesy Dr. V. Penopoulos)

A metastatic deposit on the excised gallbladder (Courtesy Dr. V. Penopoulos)

A metastatic deposit on the excised gallbladder (Courtesy Dr. V. Penopoulos)

A metastatic deposit on the excised gallbladder (Courtesy Dr. V. Penopoulos)

A metastatic deposit on the excised gallbladder (Courtesy Dr. V. Penopoulos)

A metastatic deposit on the excised gallbladder (Courtesy Dr. V. Penopoulos)

Forceps passed violently through the colonic stenosis (Courtesy Dr. V. Penopoulos)

Extreme stenosis of the involved transverse colon . Residual seeds were unable to overcome the stenotic segment (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Burns from ingestion of acids (Courtesy Dr. V. Penopoulos)

Esophagograms. Esophageal strictures (Courtesy Dr. V. Penopoulos)

Gastric burns (Courtesy Dr. V. Penopoulos)

Gastric burn. Pyloric stricture (Courtesy Dr. V. Penopoulos)

Acid ingestion (HCL). Diffuse burns and contraction/shrinkage of both the esophagus and stomach (Courtesy Dr. V. Penopoulos)

Gastric burns - Contained perforation (Courtesy Dr. V. Penopoulos)

Endoscopic image of esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Endoscopic images of esophagojejunal anastomosis (Courtesy Dr. V. Penopoulos)

Performance of transthoracic esophagojejunal anastomosis (Courtesy Dr. V. Penopoulos)

Endoscopic image of esophagocolic anastomosis (Courtesy Dr. V. Penopoulos)

Gastrografin swallow - Colonojejunal anastomosis following esophagogastrectomy for extensive esophageal and gastric burns (Courtesy Dr. V. Penopoulos)

Gastrografin swallow - Esophagogastric anastomosis (stomach within the right hemithorax) (Courtesy Dr. V. Penopoulos)

Esophagectomy - The endoprosthesis (stent) within the organ lumen is visible (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Postoperative stricture development at the esophagogastric anastomosis (Courtesy Dr. V. Penopoulos)

Different views of a double contrast-enhanced CT scan showing a left diaphragmatic hernia with an acute dilated stomach (Courtesy Dr. V. Penopoulos)

Diaphragmatic hernia before and after reduction of the stomach (Courtesy Dr. V. Penopoulos)

Water-soluble gastrografin meal showing postoperative normal positioning of stomach (Courtesy Dr. V. Penopoulos)

Water-soluble gastrografin meal showing postoperative normal positioning of stomach (Courtesy Dr. V. Penopoulos)

Water-soluble gastrografin meal showing postoperative normal positioning of stomach (Courtesy Dr. V. Penopoulos)

Esophageal leak following esophageal cinematography (Courtesy Dr. V. Penopoulos)

Esophageal leak following esophageal cinematography (Courtesy Dr. V. Penopoulos)

Esophageal leak following esophageal cinematography (Courtesy Dr. V. Penopoulos)

Duodenectomy sparing Vater s papilla .Poorly differentiated adenocarcinoma invading full thickness the duodenal wall and surrounding fatty tissue with clear cut margins (Courtesy Dr. V. Penopoulos)

Colonic carcinoma in contact with the splenic abscess cavity

Colonic carcinoma

Cholecystectomy Gallstones (Courtesy Dr. V. Penopoulos)

Neuroendocrine carcinoma (NEC) consisting of poorly differentiated tumor cells with many mitosis forming solid sheets and nests

Total gastrectomy specimen

Detailed macroscopic view of neuroendocrine carcinoma

Detailed macroscopic view of mucus adenocarcinoma

Endoscopic images Dieulafoy lesions (Courtesy Dr. V. Penopoulos)

Endoscopic images Dieulafoy lesions (Courtesy Dr. V. Penopoulos)

Endoscopic images Dieulafoy lesions (Courtesy Dr. V. Penopoulos)

Endoscopical and CT Scan images of gastric tumors

Cut surface of the tumors

Gastrectomy specimen. Green arrow - Mucus Adenocarcinoma. Blue arrow - Neuroendocrine Carcinoma

CT Scan. The gastric tumors are obvious (red arrow). Incidental finding right sided sizable renal cysts (blue arrow)

Endoscopical and CT Scan images of gastric tumors

The jejunal interposition loop is clearly seen ( Merendino’s technique ) (Courtesy Dr. V. Penopoulos)

The jejunal interposition loop is clearly seen ( Merendino’s technique ) (Courtesy Dr. V. Penopoulos)

The jejunal interposition loop is clearly seen ( Merendino’s technique ) (Courtesy Dr. V. Penopoulos)

The jejunal interposition loop is clearly seen ( Merendino’s technique ) (Courtesy Dr. V. Penopoulos)

The jejunal interposition loop is clearly seen ( Merendino’s technique ) (Courtesy Dr. V. Penopoulos)

The jejunal interposition loop is clearly seen ( Merendino’s technique ) (Courtesy Dr. V. Penopoulos)

Contrast-enhanced CT of the abdomen, revealed a grossly distended stomach with mild diffuse thickening of its wall (red arrow)

Recordings of the left recurrent laryngeal nerve potentials, before and after removal of the left thyroid lobe (Courtesy Dr. V. Penopoulos)

White arrows indicate the leak from the posterior esophageal wall (Courtesy Dr. V. Penopoulos)

Intrathoracic esophagojejunal anastomosis (Courtesy Dr. V. Penopoulos)

Intrathoracic esophagojejunal anastomosis (Courtesy Dr. V. Penopoulos)

Intrathoracic esophagojejunal anastomosis (Courtesy Dr. V. Penopoulos)

Intrathoracic esophagojejunal anastomosis (Courtesy Dr. V. Penopoulos)

Intrathoracic esophagojejunal anastomosis (Courtesy Dr. V. Penopoulos)

Intrathoracic esophagojejunal anastomosis (Courtesy Dr. V. Penopoulos)

Adenosquamous carcinoma of the upper third of the esophagus (Courtesy Dr. V. Penopoulos)

Cholecystectomy specimen

Cholecystectomy specimen

Contrast-enhanced CT of the abdomen, revealing air in intrahepatic biliary tree (pneumobilia) (red arrow)

Complete mobilization of the upper esophagus and encirclement with Penrose drains (Courtesy Dr. V. Penopoulos)

Upper gastrointestinal endoscopy showing a grossly deformed duodenal bulb. A steady trickle of bile was also seen to come from a slit-like orifice on the anterior duodenal wall suggestive of biliary duodenal fistula (green arrow)

Esophagography. Arrows demonstrate a small posterior pseudodiverticulum of the esophagus adjacent to the metallic plate and screws (Courtesy Dr. V. Penopoulos)

Esophagography. Arrows demonstrate a small posterior pseudodiverticulum of the esophagus adjacent to the metallic plate and screws (Courtesy Dr. V. Penopoulos)

Esophagoscopy. Green arrow: Esophageal pseudodiverticulum (Courtesy Dr. V. Penopoulos)

Green arrow: Sternocleidomastoid muscle. Blue arrow: Esophagus (Courtesy Dr. V. Penopoulos)

Blood supply of the sternocleidomastoid muscle (Courtesy Dr. V. Penopoulos)

Esophagojejunal anastomosis - endoscopic image on the 30th postoperative day (Courtesy Dr. V. Penopoulos).

Barium retention in the distended gastric remnant (Courtesy Dr. V. Penopoulos).

Normal jejunojejunal anastomosis (lower Roux anastomosis) (Courtesy Dr. V. Penopoulos).

Normal gastrojejunal anastomosis (Courtesy Dr. V. Penopoulos).

Specimen cut surface. The extend of the colonic carcinoma is obvious

Gastrografin swallow examination. Gastric perforation

The malignant infiltration of the anterior abdominal wall is obvious

Large fluid collection in the left side of the abdomen with multiple air bubbles

Green arrows — reconstruction of the Nissen fundoplication (Courtesy Dr. V. Penopoulos)

Postoperative image of long myotomy. Green outline — the divided muscular layers of the esophagus. The esophageal mucosa is exposed at the center. The myotomy extends onto the stomach (Courtesy Dr. V. Penopoulos)

Tertiary contractions (Courtesy Dr. V. Penopoulos)

Barium swallow. Red arrow — previous Nissen fundoplication. Yellow arrow — narrowed distal esophagus with tapering of its terminal segment. Green outline — right paraesophageal hiatal hernia (Courtesy Dr. V. Penopoulos)

Advanced sigmoid type (Courtesy Dr. V. Penopoulos)

Sigmoid type of esophageal achalasia (Courtesy Dr. V. Penopoulos)

Scleroderma esophagus (Courtesy Dr. V. Penopoulos)

Nutcracker (corkscrew) esophagus (Courtesy Dr. V. Penopoulos)

Straight type of esophageal achalasia (Courtesy Dr. V. Penopoulos)

Diffuse esophageal spasm (Courtesy Dr. V. Penopoulos)

Abdominal CT scan. Distended small bowel loops with fluid content (Courtesy Dr. V. Penopoulos)

Anatomical forceps within the fistula orifice in the duodenum (Courtesy Dr. V. Penopoulos)

Anatomical forceps within the fistula orifice in the duodenum (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Inflammatory myofibroblastic tumor of the stomach (Courtesy Dr. V. Penopoulos)

Gastric carcinoid (Courtesy Dr. V. Penopoulos)

Gastric schwannoma (Courtesy Dr. V. Penopoulos)

Red arrows – Rectal stromal tumor. Multiple liver metastases (Courtesy Dr. V. Penopoulos)

Giant gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Endoscopic view of multiple gastric stromal tumors after suctioning of hemorrhagic products (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Abdominal CT Scan demonstrating the fistula between stomach and retroperitoneum

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Abdominal CT scans. Gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Brown arrows – Multiple gastric stromal tumors (Courtesy Dr. V. Penopoulos)