Pancreaticogastrostomy and the Whipple procedure: Radiographic appearance and complications

PURPOSE: To evaluate the radiographic appearance of a pancreaticogastrostomy (PG) and its complications. MATERIALS AND METHODS: Seventy-two patients underwent pancreaticoduodenectomy and PG or pancreaticojejunostomy. Those who underwent PG and were evaluated postoperatively with T-tube cholangiography and upper gastrointestinal (UGI) series constitute the study group (n = 22; 10 men, 12 women; age range, 33- 88 years). RESULTS: Twenty-one of the patients had a gastric filling defect radiographically detected. Four patients had clinically apparent delayed gastric emptying and one patient had a clinically apparent pancreatic fistula not detected radiographically. Two patients outside the study group had complications: One had a pancreatic fistula seen only with sinography, and one had a PG leak seen only with repeat UGI series and computed tomography (CT). CONCLUSION: PG caused a gastric filling defect in most patients. Suspected pancreatic fistulas are best confirmed with sinography, and suspected PG leaks may require repeat evaluation and CT. Clinical findings of delayed gastric emptying do not correlate with findings of UGI.