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Figure 10a: Long, twisted, partially supradiaphragmatic fundoplication surrounding the stomach in a patient with dysphagia and gas bloat after surgery. (a) Semiprone (right anterior oblique) esophagram during distended single-contrast phase esophagography shows fundoplication (long arrows) surrounding gastric folds (arrowheads). As in Figure 7a, the folds surrounded by the wrap do not have a straight linear appearance but a spiral appearance indicating a twist, which is a very subtle finding and difficult to see. Position of arrowheads roughly approximates the superior and inferior extent of fundoplication. A portion of fundoplication (short arrow) has herniated above the diaphragm in paraesophageal location. (b) Retroflexed endoscopic view of fundus shows twist in gastric folds (arrows) caused by the fundoplication.
