Spiral CT Features of Abdomen After Whipple's Operation

Kim, T H; Lee, K Y; Shin, K H; Jung, M H; Park, C M; Cha, I H

Abstract

PURPOSE
To assess the CT features of postoperative anatomical changes, surgical complications, and patterns of tumor reccurence after Whipple's operation.
MATERIALS AND METHODS
42 spiral CT scans of 31 patients who had undergone Whipple's operation were retrospectively reviewed. Postoperative diagnoses were distal CBD cancer in 13 patients , cancer of the ampulla of Vater in ten, cancer of the head of the pancreas in seven, and microcystic cystadenocarcinoma of the pancreas in one. Time intervals between surgery and CT ranged from 1 week to 5 years. CT features of postoperative anastomotic changes, surgical complications, and patterns of tumor recurrence were analyzed.
RESULTS
Gastro- or duodeno-jejunal anastomosis was seen in 32 CT scans(74%), pancreaticojejunostomy in27(64%), and choledochojejunostomy in 24(57%). Pneumobilia was seen in ten patients(34%). Abnormal fluid collections in the peripancreatic and perihepatic space were demonstrated in two patients who underwent CT scanswithin 3 weeks after operation. Other complications included wound abscess(n=2), and portal vein occlusion(n=1).The most common site of metastasis was the lymph node(n=8)(retroperitoneal : n=5; mesentery root : n=4; and celiac : n=2), followed by the liver(n=6), peritoneum(n=3), adrenal gland(n=2), and afferent loop(n=1). In three cases, there was local recurrence in the pancreatic bed.
CONCLUSION
To reduce possible diagnostic errors during CT interpretation, a Knowledge of normal postoperative anatomy, common complications, and patterns of disease recurrence following Whipple's operation is important.