Computed tomography evaluation of early post-operative complications of the Whipple procedure

Purpose
Pancreaticoduodenectomy (the Whipple procedure) is the only potential curative treatment for periampullary tumours. Although mortality due to the procedure is gradually decreasing, the morbidity rates remain high. This study aimed to evaluate early computed tomography (CT) findings in patients suspected of complications following the Whipple procedure.

Material and methods
The CT images of patients who underwent the conventional Whipple procedure between January 2015 and January 2019 and underwent CT examination for the detection of early postoperative complications were retrospectively evaluated by two radiologists.

Results
The Whipple operation was performed to 65 patients, and the CT scans of 45 patients (30 males, 15 females) were included in the study. There were no complications in 21 patients. Complications were present in 24 patients (53.33%), of whom 13 had more than one complication. Eight patients had fluid collection in the operation site, two had haematoma, 10 had an abscess, and five had a pancreatic fistula. In addition, a hepatic abscess was detected in one patient, delayed gastric emptying in six patients, anastomotic leakage from the gastrojejunostomy line in two patients, superior mesenteric vein (SMV) thrombosis in two patients, and intraluminal haemorrhage and active extravasation in one patient. Mortality due to complications occurred in one patient in the early postoperative period. Other complications were treated by spontaneous, surgical or percutaneous interventional procedures.

Conclusions
Despite the decreasing mortality rates in recent years, the Whipple procedure is risky and has high morbidity even when performed in experienced centres. CT is the adequate imaging modality for the evaluation of this anatomically altered region and detection of complications.