Korean J Radiol.  2018 Apr;19(2):284-291. 10.3348/kjr.2018.19.2.284.

Prediction of Late Postoperative Hemorrhage after Whipple Procedure Using Computed Tomography Performed During Early Postoperative Period

• Han GJ
• Kim S
• Lee NK
• Kim CW
• Seo HI
• Kim HS
• Kim TU

• KMID: 2404925
• DOI: http://doi.org/10.3348/kjr.2018.19.2.284

Abstract

OBJECTIVE
Postpancreatectomy hemorrhage (PPH) is an uncommon but serious complication of Whipple surgery. To evaluate the radiologic features associated with late PPH at the first postoperative follow up CT, before bleeding.
MATERIALS AND METHODS
To evaluate the radiological features associated with late PPH at the first follow-up CT, two radiologists retrospectively reviewed the initial postoperative follow-up CT images of 151 patients, who had undergone Whipple surgery. Twenty patients showed PPH due to vascular problem or anastomotic ulcer. The research compared CT and clinical findings of 20 patients with late PPH and 131 patients without late PPH, including presence of suggestive feature of pancreatic fistula (presence of air at fluid along pancreaticojejunostomy [PJ]), abscess (fluid collection with an enhancing rim or gas), fluid along hepaticojejunostomy or PJ, the density of ascites, and the size of visible gastroduodenal artery (GDA) stump.
RESULTS
CT findings including pancreatic fistula, abscess, and large GDA stump were associated with PPH on univariate analysis (p ≤ 0.009). On multivariate analysis, radiological features suggestive of a pancreatic fistula, abscess, and a GDA stump > 4.45 mm were associated with PPH (p ≤ 0.031).
CONCLUSION
Early postoperative CT findings including GDA stump size larger than 4.45 mm, fluid collection with an enhancing rim or gas, and air at fluid along PJ, could predict late PPH.

Keyword

Whipple surgery; Late postpancreatectomy hemorrhage; Computed tomography; Complication

MeSH Terms

Abscess
Arteries
Ascites
Follow-Up Studies
Hemorrhage
Humans
Multivariate Analysis
Pancreatic Fistula
Pancreaticojejunostomy
Postoperative Hemorrhage*
Postoperative Period*
Retrospective Studies
Ulcer

Figure

• 

  Fig. 1 67-year-old male who had undergone Whipple procedure for pancreatic head cancer.A, B. Contrast-enhanced CT performed at postoperative day 7. Axial portal venous-phase CT shows fluid with air bubble around pancreaticojejunostomy (arrow) (A), suggestive of pancreatic leakage and arterial phase CT shows 10 mm-sized GDA stump (arrowhead) (B). C-F. CT and DSA performed at postoperative day 26. Non-enhanced CT shows intraluminal sentinel clot sign in stomach (arrow) (C) and arterialphase CT shows pseudoaneurysm of GDA stump (arrowhead) (D). DSA shows stump pseudoaneursym as in CT (E) and coil embolization is done successfully (F). DSA = digital subtraction angiography, GDA = gastroduodenal artery

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