From: Elucidating early CT after pancreatico-duodenectomy: a primer for radiologists
Feature | Comments |
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Report pleuropulmonary changes (such as atelectasis, pneumonia, pleural effusion) at lung bases | Particularly common in elderly patients |
Externally draining tubes present? | Use thick-slab maximum-intensity projection (MIP) reconstructions Report presence, number, course and distal tip position |
Identify - pancreatic remnant (body and tail) - main pancreatic duct (MPD) - either pancreatico-jejunostomy (PJS) or pancreatico-gastrostomy (PGS) | Best visualised in oblique-coronal images Assess calibre Assess integrity, presence of internal or external trans-anastomotic stents |
- mobilised jejunal limb | Identified by valvulae conniventes and tubular configuration on coronal images; mural oedema is generally normal |
Identify - hepatico-jejunostomy (HJS) - either gastro-jejunostomy (GJS) or duodeno-jejunostomy (DJS) - gastric dilatation | Pneumobilia and/or mild biliary tract dilatation are usually normal Respectively after Whipple and pylorus preserving PD Suggest delayed gastric emptying (optional fluoroscopy for confirmation) |
Identify fluid collections and air - surgical bed, abutting the PJS - subhepatic/right-sided - surrounding PR - pneumoperitoneum/peritonitis | Report as consistent with a clinical/laboratory diagnosis of pancreatic fistula (fat stranding, mild non-demarcated fluid, small lymphadenopathies are usually normal) Suggest bile leakage Suggest acute pancreatitis Mild residual air within 3 days is usually normal Persistent or abundant pneumoperitoneum, diffuse ascites, enhancing peritoneal serosa suggest peritonitis from major anastomotic leakage |
Search for bleeding - intraluminal in jejunum - extraluminal - hemoperitoneum | Use MIP reconstructions Compare precontrast, arterial- and portal venous phase images Always scrutinise the gastroduodenal artery “stump” |
Assess patency of splenic, portal and mesenteric veins | For postoperative thrombosis, favoured by venous resections or graft insertion |
Scrutinise laparotomic incision site | For fluid or abscess collections consistent with wound infection |