Pylorus-preserving Whipple pancreaticoduodenectomy: postoperative evaluation

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) contrast-material 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.