Postoperative findings following the Whipple procedure: determination of prevalence and morphologic abdominal CT features

This study was conducted to determine characteristic CT findings following the Whipple procedure and to evaluate the usefulness of CT in re-dieting tu mor recurrence. Eighty-four postoperative abdominal CT scans and medical re cords of 43 patients were retrospectively reviewed. Perioperative histopath ologic examinations revealed malignancy in 32 patients (74.4 %). Time inter val between surgery and CT varied from 13 days to 6 years and 7 months. Com mon postoperative findings were unopacified anastomotic bowel loops in the porta hepatis (n = 69 scans), perivascular cuffing (n = 42 scans), pneumobi lia (n = 40 scans), dilated intrahepatic bile ducts (n = 22 scans), reactiv e lymphadenopathy (n = 21 scans), and transient fluid collections (n = 20 s cans). Postoperative complications were detected on 17 CT scans (20.2 %): g eneralized ascites (n = 8 patients), deep abscesses (n = 3 patients), wound abscess (n = 1 patient), pancreatitis (n = 1 patient), pseudomembranous co litis (n = 1 patient). Tumor recurrence appeared in 15 patients (46.8 %) af ter a mean postoperative period of 11 months (1 month to 3 years): local (9 of 15), regional lymph nodes (9 of 15), and liver metastasis (8 of 15). De tection of generalized ascites more than 30 days after surgery was associat ed with tumor recurrence in 6 6 patients (100 %). Diffuse ascites (> 30 day s after surgery) behaved as an early predictive sign of tumor : recurrence. In our series CT accuracy for detecting: recurrent tumor with CT was 93.5 %. No predilection site for disease recurrence could be determined.