J Korean Radiol Soc.  1998 Mar;38(3):497-502. 10.3348/jkrs.1998.38.3.497.

Pylorus-preserving Whipple Pancreaticoduodenectomy: CT Findings of Immediate Postoperative Complications

Affiliations
  • 1Department of Diagnostic Radiology, School of Medicine, Kyungpook National University.

Abstract

PURPOSE: To determine the CT findings of immediately postoperative complications including anastomoticleakage, and to evaluate the usefulness of CT scan in the assessment of early postoperative complications ofpylorus preserving Whipple pancreaticoduodenectomy (PPPD)
MATERIALS AND METHODS
During the early postoperativeperiod, fluid accomulated in the abdominal cavity of ten of 23 patients who had undergone PPPD. In all cases, thetime interval between the first follow up CT scan and surgery was no more than two weeks. At each leakage site, wecompared CT findings with those of conventional fluoroscopic studies: upper gastrointestinal studies with oralwater-soluble contrast materials, a contrast injection study via drainage catheters in place in the stomach, thesite of choledochojejunostomy during surgery and pancreaticojejunostomy, and nine cases of sinogram viapercutaneous drainage catheters. We also evaluated CT findings of the locations, amounts, and margin of the fluidcollections. If conventional fluoroscopic studies showed no evidence of anastomotic leakage, as was the case withsix patients, the leakage site was determined on the basis of clinical and laboratory data. In four of the six,this was found to be the site of pancreaticojejunostomy, and in the other two, an abscess without anastomoticleakage.
RESULTS
Eight patients showed intra-abdominal fluid collections due to leakage at anastomotic sites: infive, this was the site of pancreaticojejunostomy, and in three, that of choledochojejunostomy. One patient showeda right subphrenic abscess, and another, a loculated fluid collection between the jejunal loops, without leakageat the anastomotic site. CT scans in all three cases with leakage at the site of choledochojejunostomy showed thesmall collection of fluid to be relatively well demarcated and confined to the areas of lesser sac or gallbladderbed. In four of five cases of leakage at the site of pancreaticojejunostomy, the large collection of fluid waswidespread; it occupied areas which included the perihepatic and peripancreatic space, as well as the paracolicgutters and pelvic cavity.
CONCLUSION
In some cases of suspected complications arising after PPPD, and includinganastomotic leakage and abdominal abscess, leakage is not revealed by conventional fluoroscopic studies; in suchcases, CT scanning may help detect the complications and determine the site of anastomotic leakage.

Keyword

Pancreas, CT; Pancreas, surgery; Surgery, complications

MeSH Terms

Abdominal Abscess
Abdominal Cavity
Abscess
Anastomotic Leak
Catheters
Choledochostomy
Contrast Media
Drainage
Follow-Up Studies
Humans
Pancreaticoduodenectomy*
Pancreaticojejunostomy
Peritoneal Cavity
Postoperative Complications*
Stomach
Subphrenic Abscess
Tomography, X-Ray Computed
Contrast Media

Figure

  • Fig. 1. A 69-year-old man with leakage at the site of pancreaticojejunostomy 2 weeks after pylorus-preserving Whipple pancreaticoduodenectoy for the malignancy in the pancreatic head. The leakage of the site of pancreaticojejunostomy is determined by clinical data. A. At the level of the splenic hilum, CT scan shows widespread fluid collections in the perihepatic, perisplenic space and lesser sac. B. CT scan 12cm inferior to Β shows fluid collection in both paracolic gutters. C. CT scan 5cm inferior to C shows large amount fluid collection in the pelvic cavity D. Fluoroscopic study with contrast injection through the percutaneous transhepatic biliary drainage catheter can not reveals the site of pancreaticojejunostomy and leakage at this site.

  • Fig. 2. A 52-year-old man with leakage at the site of choledochojejunostomy 1 week after pylorus preserving Whipple pancreaticoduodenectomy for the malignancy of the pancreatic head. The leakage site is determine! by conventional fluoroscopic study. A. CT scan reveals well demarcated fluid collection at the lesser sac. B. Fistulogram through the percutaneous drainage catheter reveals communication of abscess cavity with the biliary trees.


Reference

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