Pancreatic transplantation using portal venous and enteric drainage: The postoperative appearance of a new surgical procedure

Purpose: To review the normal radiologic appearance of pancreatic transplan ts that use portal venous and enteric drainage, and to review the appearanc e of a variety of postoperative complications. Method: We retrospectively reviewed the computed tomographic (CT) scans, ma gnetic resonance (MR) images, and ultrasounds of patients who had undergone pancreatic transplantation using portal venous and enteric drainage. Results: At CT, the normal pancreatic transplant appears as a heterogeneous mass composed of pancreatic parenchyma, vessels, and omental wrap. On MR i maging, a normal transplant demonstrates intermediate signal intensity on T 1- and T2-weighted sequences. Sonographic evaluation of a normal transplant reveals a hypoechoic gland that contains readily detectable low-resistance arterial and venous Doppler waveforms. Acute postoperative complications i nclude acute rejection, which has a nonspecific radiologic appearance, and transplant pancreatitis, which is often manifested on CT by stranding of th e peritransplant fat. Chronic postoperative complications include small bow el obstructions, graft pancreatitis secondary to obstruction of the Roux lo op, and chronic rejection. Conclusion: Knowledge of the radiologic appearance of the normal pancreatic transplant is required before transplant-related complications can be dete cted.