CT Features of Pancreatic Fistula After Pancreaticoduodenectomy

Hashimoto, Manabu; Koga, Makoto; Ishiyama, Koichi; Watarai, Jiro; Shibata, Satoshi; Sato, Tutomu; Yamamoto, Yūzō

doi:10.2214/ajr.05.1174

Cited by 28 publications

(25 citation statements)

References 16 publications

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“…Reoperation was necessary in case of sepsis sustained by complex collections not sufficiently drained by percutaneous procedures, in case of complete dehiscence of the anastomosis, with evidence of air bubbles near the anastomosis at the CT scan [8,9,11] and/or septic status and in case of late bleeding provoked by the fistula.…”

Section: Discussionmentioning

confidence: 99%

A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients

Daskalaki

Butturini

Molinari

et al. 2010

Langenbecks Arch Surg

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Section: Discussionmentioning

confidence: 99%

A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients

Daskalaki

Butturini

Molinari

et al. 2010

Langenbecks Arch Surg

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“…The presence of air bubbles was recorded for each fluid collection. The radiologists considered any fluid collection adjacent to the pancreaticogastric or pancreaticojejunal anastomosis a pancreatic fistula [26].…”

Section: Image Analysismentioning

confidence: 99%

“…The interval between surgery and CT was based on observations that the diagnosis of pancreatic fistula is made an average of 7 days after pancreaticoduodenectomy [5,14,15]. One study [26] showed that a fluid collection seen around the pancreaticojejunostomy site and in the pancreatic bed on CT images may be caused by pancreatic fistula in patients who have undergone pancreaticoduodenectomy. That study, however, was limited by selection bias: Only patients with clinically suspected complications were included.…”

Section: Ct Of Pancreatic Fistulamentioning

confidence: 99%

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Bruno

Brancatelli

Sauvanet

et al. 2009

American Journal of Roentgenology

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W175as "drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase content greater than three times the serum amylase activity" [11].The overall rate of pancreatic fistula after pancreaticoduodenectomy ranges from 17% in patients in whom the pancreatic remnant has a hard consistency [12] and exocrine pancreatic function and pancreatic juice output are impaired [13] to 25% in cases in which the pancreas is soft [1], that is, the parenchyma is normal [13]. Soft pancreatic texture [1,3,13] and small pancreatic duct size [3] are the most important preoperative risk factors for the development of pancreatic fistula.The diagnosis of pancreatic fistula usually is made an average of 7 days after pancreaticoduodenectomy [5,14,15]. Pancreatic fistula diagnosed with repeated assays of pancreatic enzymes in peripancreatic fluid drainage [11,14,16] © American Roentgen Ray Society P ancreaticoduodenectomy is safe in the management of various malignant and benign diseases of the pancreatic head and periampullary region. Although the mortality rate has decreased to approximately 1-2% at high-volume centers, the morbidity rate ranges from 30% to 50% [1][2][3][4]. The two most frequent complications of pancreaticoduodenectomy are delayed gastric emptying and pancreatic fistula. G a s t r oi nt e s t i n a l I m ag i ng • O r ig i n a l R e s e a rc hPancreatic fistula after pancreaticoduodenectomy is a serious complication resulting in prolonged hospital stay, increased costs, readmission, and a mortality rate of 3-9% [5,6]. Efforts to reduce the incidence of pancreatic fistula have included definition of risk factors [1,7], improvement of surgical technique [8,9], and perioperative administration of somatostatin and its analogues [1,10]. The International Study Group on Pancreatic Fistula has defined pancreatic fistula OBJECTIVE. The purpose of this study was to evaluate the sensitivity and specificity of routine performance of CT on postoperative day 7 in patients at high risk of pancreatic fistula after pancreaticoduodenectomy.MATERIALS AND METHODS. Two radiologists analyzed images from CT examinations of 50 patients with soft pancreas 7 days after pancreaticoduodenectomy. Pancreatic fistula was defined at CT as a fluid collection close to the pancreaticogastric or pancreaticojejunal anastomosis. Clinicobiologic criteria for the diagnosis of pancreatic fistula were drain output of any measurable volume of fluid on or after postoperative day 3 that had an amylase content more than three times the serum amylase activity. The final diagnosis of pancreatic fistula was rendered on the basis of clinicobiologic data at hospital discharge or at first readmission.RESULTS. At hospital discharge or at first readmission, 27 of 50 patients (54%) had a pancreatic fistula. On postoperative day 7, 30 patients (60%) had a total of 51 fluid collections, and CT showed a fluid collection close to the pancreaticogastric or pancreaticojejunal anastomosis in 21 of 51 cases. CT had a sensitivity of 63% (17/27 pat...

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“…According to widespread opinions in the literature, postoperative complications after pancreatic surgery including POPF, can be identified by cross-sectional imaging [789]. It is also generally accepted that US is not a reliable imaging modality for deep abdominal organs and pathologies.…”

Section: Discussionmentioning

confidence: 99%

“…Although routine imaging is generally not used for the early identification of POPF [67], with the advances in the technology of US, it is not surprising that surgeons tend to perform an transabdominal US to evaluate the potential abdominal fluid collections. There have been very limited data published on transaabdominal US examination during the early postoperative period after pancreatic surgery.…”

Section: Introductionmentioning

confidence: 99%

Does the abdominal ultrasonography reliable in the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy in the first postoperative week?

Kinaci¹,

Sevinç²,

Bayrak³

et al. 2016

Ann Surg Treat Res

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PurposeWe evaluated the efficacy of ultrasonography (US) in the early postoperative period after pancreaticoduodenectomy (PD) to diagnose postoperative-pancreatic-fistula (POPF). Early diagnosis is important to prevent POPF-dependent mortality after PD. The value of radiological modalities for early diagnosing POPF is not clear.MethodsForty-five patients who underwent transabdominal-US in the first postoperative week after PD were retrospectively evaluated. Two types of grouping methods were performed. Firstly, peripancreatic or perianastomotic fluid collections at least 2 cm in diameter were considered to be a primary positive result on US. Patients then divided into 2 groups: group 1, US-positive and group 2, US-negative. Secondly, to increase the power of US, in addition to primary positive results, the presence of fever, leukocytosis or hyperamylasemia was considered to be a secondary positive result (group 1S). The remaining patients were considered to have secondary negative results (group 2S). The sensitivity and specificity for both grouping methods were calculated for the diagnosis of PF and clinically important PF (ciPF), according to the International Study Group on Pancreatic Fistula criteria.ResultsFor the first grouping method, the sensitivity was 36% and 28% and the specificity was 80% and 85% for PF and ciPF, respectively. For the second grouping method, the sensitivity was 36% and 29% and the spesificity was 74% and 81% for PF and ciPF, respectively. The unloculated fluid collections were not related to a significant increase in the risk of POPF (P = 0.694).ConclusionAbdominal-US has low sensitivity and high specificity for the early diagnosis of POPF after PD.

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CT Features of Pancreatic Fistula After Pancreaticoduodenectomy

Cited by 28 publications

References 16 publications

A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients

A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Does the abdominal ultrasonography reliable in the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy in the first postoperative week?

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