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Figure 9a: Long, twisted, tight fundoplication surrounding the stomach in a patient with solid food dysphagia after surgery. (a) Semiprone (right anterior oblique) esophagram during distended single-contrast phase shows leaves of fundoplication (arrows) surrounding only gastric folds (arrowheads). Wrap length is at least 4 cm, as estimated when compared with 13-mm tablet. Position of arrowheads roughly approximates superior and inferior extent of fundoplication. Gastric folds surrounded by the wrap do not have straight linear appearance (arrowheads) but a somewhat spiral appearance indicating a twist, which is a very subtle finding and difficult to see. (b) Upright anteroposterior spot radiograph of fundus after ingestion of 13-mm tablet (T) shows that tablet is obstructed above the level of the wrap (arrow). Poorly coated fundus is seen in lower right quarter.
