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

¹ Université Paris 7 Denis Diderot, Paris F-75018, France.
² AP-HP, Department of Radiology, Hôpital Beaujon, Clichy, France.
³ Department of Radiology, Università di Palermo, Via Villaermosa 29, Palermo, 90139, Italy.
⁴ University of Pittsburgh School of Medicine, Pittsburgh, PA.
⁵ Radiology Unit, La Maddalena Hospital, Palermo, Italy.
⁶ Service de Chirurgie Digestive, Hôpital Beaujon, Clichy F-92100, France.
⁷ INSERM, U773, Centre de Recherché Biomédicale Bichat-Beaujon, Paris F-75018, France.

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 patients) and a specificity of 83% (19/23 patients) for the diagnosis of pancreatic fistula with four false-positive and 10 false-negative findings. The diagnosis of pancreatic fistula on the basis of clinicobiologic criteria on postoperative day 7 was made in 22 of 27 patients (81%), whereas five cases were false-negative. Four of these patients had CT evidence of pancreatic fistula.

CONCLUSION. In patients at high risk who have undergone pancreaticoduodenectomy, systematic postoperative CT may be proposed as a complementary tool in the diagnosis of pancreatic fistula, particularly for detection of clinically occult pancreatic fistula.

Keywords: CT • pancreas • pancreaticoduodenectomy • pancreatic fistula • soft pancreas

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