Journal of Computer Assisted Tomography; 26(6):956-961.
Johnson PT, Curry CA, Urban BA, Fishman EK.
Following a Whipple procedure for a patient with pancreatic cancer, postoperative imaging with CT is essential to exclude complications and to identify recurrence. Accurate interpretation of these examinations requires knowledge of the type of surgery performed and the normal appearance of the abdomen on CT following this complex surgery. The purpose of this pictorial essay is to illustrate the normal appearance of the bowel following a Whipple procedure as well as some of the complications.
Spiral CT has been shown to be an excellent modality for the diagnosis and staging of pancreatic adenocarci-noma, with an overall accuracy of >90% (1). Although the majority of patients have unresectable disease at the time of diagnosis, for those patients with resectable disease who undergo pancreaticoduodenectomy (Whipple procedure), the 5 year survival approaches 20% (2). For those patients who undergo a Whipple procedure, dynamic spiral CT is the study of choice to monitor for postoperative complications as well as local recurrence and metastatic disease.
The postoperative appearance in patients who have undergone a Whipple procedure has been described and is often complex with characteristics that emulate both benign and malignant processes (3-6). The diagnosis of recurrent disease is further complicated by postoperative complications and changes due to treatment with radiation and chemotherapy. Accurate interpretation of these complex postoperative exams requires knowledge of the type of surgery performed, including surgical anastomoses, the interval between surgery and imaging, and whether the patient has received any ancillary treatment such as radiation or chemotherapy. Optimizing scanning techniques and a strong familiarity with the postoperative exam are essential to the early detection of recurrent and metastatic disease and to avoid false-positive or false-negative interpretations.