M. Ambrosetti, Verona, IT

The purpose of this study is to describe the early postoperative findings at MRI after pancreaticoduodenectomy, in order to identify patients at risk of developing complications including pancreatic and biliary fistula

Material and methods

We reviewed the MR exams performed between March 2019 and November 2019 in 16 patients (11 males, 5 females) as part of an IRB-approved prospective study. All patients underwent MRI on the 3^rd postoperative day after pancreaticoduodenectomy. Two readers reviewed the exams and assessed: thickness and signal intensity of the pancreatic parenchyma, caliber of the main pancreatic duct, presence of fluid collections adjacent to the pancreatic and biliary anastomosis, and morphology of the jejunal stump. These findings were compared with clinical and laboratory data

Results

In 13/16 patients the parenchymal thickness and signal intensity was regular, in 3/16 patients the parenchyma was atrophic with low signal intensity on T1-weighted fat-suppressed images. Only one patient presented MPD dilation. Abdominal fluid was found in all patients. Four patients had only mild retroperitoneal fluid, 4/16 presented a homogeneous fluid collection adjacent to the pancreatic anastomosis, 8/16 presented a homogeneous fluid collection adjacent to both pancreatic and biliary anastomosis. Of these 8 patients, 3 developed a biliary fistula and 3 a pancreatic fistula. Thickening of the walls of the jejunal anastomotic loop was present in 3/11 patients

Conclusion

The most common early MR finding after pancreaticoduodenectomy was the presence of abdominal fluid. Only patients who also presented homogeneous fluid collections adjacent to the pancreatic and biliary anastomosis developed complications such as pancreatic and biliary fistulas.

Collapse