Complications after pancreatoduodenectomy: Imaging and imaging-guided interventional procedures

Over the past decade, performance of the Whipple procedure, or pancreatoduo denectomy, to treat both malignant and benign disease has increased. This i ncrease is in large part due to the decreasing perioperative mortality rate , which is down from historic highs of 25% to the 1.0%-1.5% now achieved in large centers. Although advances in surgical management have improved the outlook for patients undergoing pancreatoduodenectomy, the improving mortal ity rate is also in part attributed to improvements over the past 2 decades in cross-sectional imaging and imaging-guided interventional procedures. A lthough the mortality rates have improved, the morbidity, or rate of compli cations, has remained relatively constant. Contributions by radiologists in both diagnosis and treatment of complications are crucial in certain patie nts with postpancreatoduodenectomy abdominal abscesses, bilomas, liver absc ess, and biliary obstruction. Familiarity with normal variations in the pos toperative appearance of the upper abdomen, awareness of pitfalls in interp retation, and knowledge of the available imaging-guided interventions will facilitate recognition of postpancreatoduodenectomy complications and allow prompt triage of patients to imaging-guided interventions.