DIAGNOSIS OF DUODENAL LEAKS FROM KIDNEY-PANCREAS TRANSPLANTS IN PATIENTS WITH DUODENOVESICAL ANASTOMOSES - VALUE OF CT CYSTOGRAPHY

OBJECTIVE. This study was undertaken to assess the value of CT cystogr aphy, using scans made with full bladder distention by a combination o f iodinated contrast material and air and scans made after active void ing, for detecting duodenal segment leaks in patients with kidney tran splants and pancreas transplants associated with small duodenal segmen ts and duodenovesical anastomoses. SUBJECTS AND METHODS. 18 patients w ith such kidney-pancreas transplants underwent CT cystography for clin ically suspected leaks from the duodenal segment. Six patients had two examinations, resulting in 24 CT cystograms. The CT protocol consiste d of an initial series of pelvic scans (plain CT) without oral, IV, or bladder contrast material; CT cystogram with the bladder fully disten ded by iodinated contrast material and air; and, if the findings were negative. CT after voiding. If no leak was demonstrated, the remainder of the abdomen to the liver dome was examined. Diagnoses were proved by surgery or cystoscopy (n = 11) and clinical follow-up examinations (n = 13). RESULTS. Overall, bladder-duodenal segment leaks were demons trated in 71 of 12 studies: one by plain CT, seven by full CT cystogra phy, and four by CT after voiding following negative findings on full CT cystography. One surgically proved leak was missed by CT cystograph y owing to a large amount of pelvic fluid. In 12 studies without a lea . CT cystography results correlated well with clinical follow-up studi es. There were no false-positive results. Sensitivity was 92%, specifi city was 100%, and accuracy was 96%. CONCLUSION. CT cystography with a dedicated protocol is an accurate way to diagnose leaks of the duoden al segment in patients with bladder-drained kidney-pancreas transplant s if administration of air combined with contrast material into the bl adder and CT after voiding are used.