Imaging of Post Pancreatic Surgery

  • R. Graziani
  • S. Mautone
  • M. C. Ambrosetti
  • M. Barillari
  • R. Manfredi
  • R. Pozzi Mucelli
Part of the Medical Radiology book series (MEDRAD)


Imaging plays an important role in pancreatic post-surgery patients. Because of its high spatial resolution, Multi Detector-row Computed Tomography (MDCT) is the most appropriate Imaging modality for evaluation of the normal aspects of pancreas and pancreatic region after surgery, for detection of post-surgery complications in early post-operative period and disease progression in neoplastic patients submitted to surgery treatment in delayed post-operative period. For these reasons, MDCT examination is performed routinely in pancreatic post-surgical patients. Magnetic Resonance (MR) alternatively can be used in case of hypersensibility reaction to CT intravenous iodinated contrast medium, renal insufficiency or when biliary ducts examination is necessary. MDCT study is performed in patients who have undergone pancreatic surgery in early post-surgery period, when there is clinical, laboratory and/or ultrasound suspicion of complications and later, for follow-up imaging, generally at 3–6 months intervals in neoplastic patients depending on their clinical situation. Thin detector collimation thickness (ideally 1 mm), axial, multiplanar (coronal, sagittal, curve) and 3D reconstruction images analysis is recommended to extensively evaluate post-surgery normal vascular anatomy, site of gastro-intestinal and biliary anastomosis and complications.


Pancreatic Fistula Pancreatic Surgery Open Distal Pancreatectomy Central Pancreatectomy Remnant Pancreas 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Bares R, Klever P, Hauptmann S et al (1994) F-18 fluorodeoxyglucose PET in vivo evaluation of pancreatic glucose metabolism for detection of pancreatic cancer. Radiology 192:79–86PubMedGoogle Scholar
  2. Bluemke DA, Fishman EK, Kuhlman J (1992) CT evaluation following Whipple procedure: potential pitfalls in interpretation. J Comput Assist Tomogr 16:704–708PubMedCrossRefGoogle Scholar
  3. Bluemke DA, Abrams RA, Yeo CJ, Cameron JL, Fishman EK (1997) Recurrent pancreatic adenocarcinoma: spiral CT evaluation following the Whipple procedure. Radiographics 17:303–313PubMedGoogle Scholar
  4. Buchler MW, Friess H, Wagner M, Kulli C, Wagener V, Z’Graggen K (2000) Pancreatic fistula after pancreatic head resection. Br J Surg 87:883–889PubMedCrossRefGoogle Scholar
  5. Butturini G, Marcucci S, Molinari E et al (2006) Complications after pancreaticoduodenectomy: the problem of current definitions. J Hepatobiliary Pancreat Surg 13:207–211PubMedCrossRefGoogle Scholar
  6. Cheng Q, Zhang B, Zhang Y et al (2007) Predictive factors for complications after pancreaticoduodenectomy. J Surg Res 139:22–29PubMedCrossRefGoogle Scholar
  7. Christein JD, Kim AW, Jakate S, Deziel DJ (2002) Central pancreatectomy for a pancreatic ganglioneuroma in a patient with previous neuroblastoma. Pancreatology 2:557–560PubMedCrossRefGoogle Scholar
  8. Coombs RJ, Zeiss J, Howard JM, Thomford NR, Merrick HW (1990) CT of the abdomen after the Whipple procedure: value in depicting postoperative anatomy, surgical complications, and tumor recurrence. AJR Am J Roentgenol 154:1011–1014PubMedGoogle Scholar
  9. Dalla Valle R, Mancini C, Crafa P, Passalacqua R (2006) Pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy. JOP 7:473–477PubMedGoogle Scholar
  10. Delbeke D, Rose DM, Chapman WC et al (1999) Optimal interpretation of FDG PET in the diagnosis, staging and management of pancreatic carcinoma. J Nucl Med 40:1784–1791PubMedGoogle Scholar
  11. DeOliveira ML, Winter JM, Schafer M et al (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244:931–937( discussion 937–939)Google Scholar
  12. Ferrone CR, Brennan MF, Gonen M et al (2008) Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg 12:701–706PubMedCrossRefGoogle Scholar
  13. Gervais DA, Fernandez-del Castillo C, O’Neill MJ, Hahn PF, Mueller PR (2001) Complications after pancreatoduodenectomy: imaging and imaging-guided interventional procedures. Radiographics 21:673–690PubMedGoogle Scholar
  14. Graziani R, Cicero C, Casagranda G, Mehrabi S et al (2007) Pancreas. In: Pozzi Mucelli R (eds) TC Multistrato dell’addome. Idelson-Gnocchi, Napoli, pp 193–262Google Scholar
  15. Graziani R, Cicero C, Casagranda G, Contro A et al (2008) Pancreas operato. In: Graziani R, Pozzi Mucelli R (eds) TC multistrato del pancreas. Idelson-Gnocchi, Napoli, pp 217–245Google Scholar
  16. Johnson PT, Curry CA, Urban BA, Fishman EK (2002) Spiral CT following the Whipple procedure: distinguishing normal postoperative findings from complications. J Comput Assist Tomogr 26:956–961PubMedCrossRefGoogle Scholar
  17. Lepanto L, Gianfelice D, Dery R, Dagenais M, Lapointe R, Roy A (1994) Postoperative changes, complications, and recurrent disease after Whipple’s operation: CT features. AJR Am J Roentgenol 163:841–846PubMedGoogle Scholar
  18. Miedema BW, Sarr MG, van Heerden JA, Nagorney DM, McIlrath DC, Ilstrup D (1992) Complications following pancreaticoduodenectomy. Current management. Arch Surg 127:945–949 (discussion 949–950)Google Scholar
  19. Mortele KJ, Lemmerling M, de Hemptinne B, De Vos M, De Bock G, Kunnen M (2000) Postoperative findings following the Whipple procedure: determination of prevalence and morphologic abdominal CT features. Eur Radiol 10:123–128PubMedCrossRefGoogle Scholar
  20. Poon RT, Fan ST, Lo CM et al (2007) External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 246:425–433 (discussion 433–425)Google Scholar
  21. Ruf J, Lopez Hanninen E, Oettle H et al (2005) Detection of recurrent pancreatic cancer: comparison of FDG-PET with CT/MRI. Pancreatology 5:266–272PubMedCrossRefGoogle Scholar
  22. Scialpi M, Scaglione M, Volterrani L et al (2005) Imaging evaluation of post pancreatic surgery. Eur J Radiol 53:417–424PubMedCrossRefGoogle Scholar
  23. Singh AK, Gervais D, Mueller P (2004) Pancreatoduodenectomy: imaging and image-guided interventional treatment. Semin Ultrasound CT MR 25:252–260PubMedCrossRefGoogle Scholar
  24. Smith SL, Hampson F, Duxbury M, Rae DM, Sinclair MT (2008) Computed tomography after radical pancreaticoduodenectomy (Whipple’s procedure). Clin Radiol 63:921–928PubMedCrossRefGoogle Scholar
  25. Tamm EP, Jones B, Yeo CJ, Maher MM, Cameron JL (1995) Pancreaticogastrostomy and the Whipple procedure: radiographic appearance and complications. Radiology 196:251–255PubMedGoogle Scholar
  26. Tani M, Onishi H, Kinoshita H et al (2005) The evaluation of duct-to-mucosal pancreaticojejunostomy in pancreaticoduodenectomy. World J Surg 29:76–79PubMedCrossRefGoogle Scholar
  27. Topal B, Aerts R, Hendrickx T, Fieuws S, Penninckx F (2007) Determinants of complications in pancreaticoduodenectomy. Eur J Surg Oncol 33:488–492PubMedCrossRefGoogle Scholar
  28. Trerotola SO, Jones B, Crist DW, Cameron JL (1989) Pylorus-preserving Whipple pancreaticoduodenectomy: postoperative evaluation. Radiology 171:735–738PubMedGoogle Scholar
  29. Zins M, Loriau J, Boulay-Coletta I, Julles M, Petit E, Sauvanet A (2009) Postoperative imaging of the pancreas and duodenum. J Radiol 90:918–936PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • R. Graziani
    • 1
  • S. Mautone
    • 1
  • M. C. Ambrosetti
    • 1
  • M. Barillari
    • 1
  • R. Manfredi
    • 1
  • R. Pozzi Mucelli
    • 1
  1. 1.Department of RadiologyPoliclinico G.B. Rossi, University of VeronaVeronaItaly

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