MDCT Evaluation of Anastomotic Sites in Patients with Whipple Surgery: What Radiologists Need to Know

Whipple surgery, also known as pancreaticoduodenectomy, is a complex surgery used to treat neoplasms involving the pancreas, duodenum and common bile duct (CBD). It is a ‘resection and anastomosis’ surgery involving resection of the pancreatic head and uncinate process, duodenum, CBD and gall bladder with anastomosis of jejunum with remnant pancreas, stomach and common hepatic duct. This procedure is associated with significant distortion of the normal anatomy as well as many post-operative complications. In this article, we aim to understand the basic surgical techniques of pancreaticoduodenectomy, the correct computed tomography (CT) protocol that needs to be employed, the normal findings which may be misinterpreted as post-operative complications and also review the imaging findings of various complications involving the anastomotic sites, like pancreatic fistula, anastomotic strictures, anastomotic leaks and abscesses. The awareness of normal post-operative findings and these complications is necessary to guide appropriate treatment strategies.