Complications After Pancreatoduodenectomy

Imaging and Imaging-Guided Interventional Procedures

http://radiographics.rsna.org/content/21/3/673.full

Debra A. Gervais, MD ; Carlos Fernandez-del Castillo, MD ; Mary Jane O’Neill, MD ; Peter F. Hahn, MD, PhD ; Peter R. Mueller, MD

1 From the Department of Radiology, Division of Abdominal Imaging and Intervention (D.A.G., M.J.O., P.F.H., P.R.M.), and Department of Surgery (C.F.C.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114. Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received October 9, 2000; revision requested October 26 and received December 13; accepted December 18.

Over the past decade, performance of the Whipple procedure, or pancreatoduodenectomy, to treat both malignant and benign disease has increased. This increase is in large part due to the decreasing perioperative mortality rate, which is down from historic highs of 25% to the 1.0%–1.5% now achieved in large centers. Although advances in surgical management have improved the outlook for patients undergoing pancreatoduodenectomy, the improving mortality rate is also in part attributed to improvements over the past 2 decades in cross-sectional imaging and imaging-guided interventional procedures. Although the mortality rates have improved, the morbidity, or rate of complications, has remained relatively constant. Contributions by radiologists in both diagnosis and treatment of complications are crucial in certain patients with postpancreatoduodenectomy abdominal abscesses, bilomas, liver abscess, and biliary obstruction. Familiarity with normal variations in the postoperative appearance of the upper abdomen, awareness of pitfalls in interpretation, and knowledge of the available imaging-guided interventions will facilitate recognition of postpancreatoduodenectomy complications and allow prompt triage of patients to imaging-guided interventions.