Radiology, Vol 171, 735-738, Copyright © 1989 by Radiological Society of North America
Pylorus-preserving Whipple pancreaticoduodenectomy: postoperative evaluation
SO Trerotola, B Jones, DW Crist and JL Cameron
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
The pylorus-preserving Whipple pancreaticoduodenectomy is becoming a
popular alternative to the standard Whipple operation. Fluoroscopy plays an
important role in postoperative assessment. The authors evaluated images of
50 consecutive patients who had undergone the newer procedure. Thirty-one
complications were identified. Two normal variants that could be confused
with abnormalities were noted: (a) the featureless appearance of the
duodenal bulb may be mistaken for extravasation, and (b) contrastmaterial
filling of the proximal jejunal loop at an end-to-end anastomosis with
retained invaginated pancreas may be mistaken for intussusception. Another
pitfall was failure to evaluate the pancreaticojejunostomy anastomosis
fully, resulting in false-negative radiologic interpretations when leaks
were present. The approach to postoperative examination of patients who
have undergone the pylorus-preserving Whipple procedure is different from
that of patients who have undergone the standard procedure. Radiologists
should be familiar with this approach, the normal postoperative anatomy,
and pitfalls in imaging so that complications can be diagnosed and treated.
