CT of the abdomen after the Whipple procedure: value in depicting postoperative anatomy, surgical complications, and tumor recurrence

We performed a retrospective study of CT scans in 29 patients who had undergone the Whipple procedure (radical pancreaticoduodenectomy) to study the CT appearance of the postsurgical anatomy and assess the use of CT in the evaluation of early postoperative complications and recurrent tumor. In the postoperative period, the scans from 15 patients revealed seven transient fluid collections; four deep abscesses, three of which were successfully drained under CT guidance; three superficial abscesses; and five cases of ascites. In 19 patients, CT scans were obtained up to 4 years after surgery to search for recurrent tumor. The most frequent site of recurrence was the liver. CT correctly identified liver metastases in six of seven patients and was falsely positive in one. Recurrence also was found twice in retroperitoneal lymph nodes; one time each in the mesenteric root, spleen, and lung base; and twice causing afferent loop blockage. Surgical proof of recurrence was obtained in eight cases. Our experience suggests that an understanding of the normal postoperative anatomy following the Whipple procedure is essential in evaluating postoperative CT scans. Scans obtained for detection of tumor recurrence should be optimized for imaging the liver because this was the most frequent site of recurrence.