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

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.