Skip to main content

Advertisement

SpringerLink
Log in

Total pancreatectomy and islet autotransplantation for chronic pancreatitis: spectrum of postoperative CT findings

  • Pictorial Essay
  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Improved laboratory methods for preparing islets for autotransplantation and postoperative care for the apancreatic patient have led to a surge in centers performing total pancreatectomy with islet autotransplantation. Accordingly, imaging in this patient population is increasingly being performed. The purpose of this article is to review the expected normal postoperative findings unique to the procedure and common complications on dual phase CT in the immediate postoperative and long-term periods.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others

References

  1. Mihaljevic AL, Kleeff J, Friess H, Buchler MW, Beger HG (2008) Surgical approaches to chronic pancreatitis. Best Pract Res Clin Gastroenterol 22(1):167–181. doi:10.1016/j.bpg.2007.10.015

    Article  PubMed  Google Scholar 

  2. Brock C, Nielsen LM, Lelic D, Drewes AM (2013) Pathophysiology of chronic pancreatitis. World J Gastroenterol 19(42):7231–7240. doi:10.3748/wjg.v19.i42.7231

    Article  PubMed Central  PubMed  Google Scholar 

  3. Talukdar R, Reddy DN (2013) Pain in chronic pancreatitis: managing beyond the pancreatic duct. World J Gastroenterol 19(38):6319–6328. doi:10.3748/wjg.v19.i38.6319

    Article  PubMed Central  PubMed  Google Scholar 

  4. Mayerle J, Hoffmeister A, Werner J, et al. (2013) Chronic pancreatitis—definition, etiology, investigation and treatment. Dtsch Arztebl Int 110(22):387–393. doi:10.3238/arztebl.2013.0387

    PubMed Central  PubMed  Google Scholar 

  5. Neal CP, Dennison AR, Garcea G (2012) Surgical therapy in chronic pancreatitis. Minerva Gastroenterol Dietol 58(4):377–400

    CAS  PubMed  Google Scholar 

  6. Gourgiotis S, Germanos S, Ridolfini MP (2007) Surgical management of chronic pancreatitis. Hepatobiliary Pancreat Dis Int 6(2):121–133

    PubMed  Google Scholar 

  7. Duffy JP, Reber HA (2002) Surgical treatment of chronic pancreatitis. J Hepatobiliary Pancreat Surg 9(6):659–668. doi:10.1007/s005340200091

    Article  PubMed  Google Scholar 

  8. Braasch JW, Vito L, Nugent FW (1978) Total pancreatectomy of end-stage chronic pancreatitis. Ann Surg 188(3):317–322

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Okamura Y, Sugimoto H, Yamada S, et al. (2012) Risk factors for hepatic steatosis after pancreatectomy: a retrospective observational cohort study of the importance of nutritional management. Pancreas 41(7):1067–1072. doi:10.1097/MPA.0b013e31824c10ab

    Article  PubMed  Google Scholar 

  10. Andersen DK, Frey CF (2010) The evolution of the surgical treatment of chronic pancreatitis. Ann Surg 251(1):18–32. doi:10.1097/SLA.0b013e3181ae3471

    Article  PubMed  Google Scholar 

  11. Bellin MD, Freeman ML, Gelrud A, et al. (2014) Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. Pancreatology 14(1):27–35. doi:10.1016/j.pan.2013.10.009

    Article  PubMed Central  PubMed  Google Scholar 

  12. Dunderdale JMJ, McNeal SF, Bryant SM, et al. (2012) Should pancreatectomy with islet cell autotransplantation in patients with chronic alcoholic pancreatitis be abandoned? J Am Coll Surg 216(4):591–596

    Article  Google Scholar 

  13. Morgan K, Owczarski SM, Borckardt J, et al. (2012) Pain control and quality of life after pancreatectomy with islet autotransplantation for chronic pancreatitis. J Gastroint Surg 16(1):129–133 (discussion 133–124). doi:10.1007/s11605-011-1744-y

    Article  Google Scholar 

  14. Dunderdale J, McAuliffe JC, McNeal SF, et al. (2013) Should pancreatectomy with islet cell autotransplantation in patients with chronic alcoholic pancreatitis be abandoned? J Am Coll Surg 216(4):591–596 (discussion 596-598). doi:10.1016/j.jamcollsurg.2012.12.043

    Article  PubMed  Google Scholar 

  15. Walsh RM, Saavedra JR, Lentz G, et al. (2012) Improved quality of life following total pancreatectomy and auto-islet transplantation for chronic pancreatitis. J Gastrointest Surg 16(8):1469–1477. doi:10.1007/s11605-012-1914-6

    Article  CAS  PubMed  Google Scholar 

  16. Wu Q, Zhang M, Qin Y, et al. (2015) Systematic review and meta-analysis of islet autotransplantation after total pancreatectomy in chronic pancreatitis patients [Review]. Endocr J. doi:10.1507/endocrj.EJ14-0510

    Google Scholar 

  17. Wilson GC, Sutton JM, Abbott DE, et al. (2014) Long-term outcomes after total pancreatectomy and islet cell autotransplantation: is it a durable operation? Ann Surg 260(4):659–665 (discussion 665–657). doi:10.1097/SLA.0000000000000920

    Article  PubMed  Google Scholar 

  18. Bramis K, Gordon-Weeks AN, Friend PJ (2012) Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis. Br J Surg 99(6):761–766. doi:10.1002/bjs.8713

    Article  CAS  PubMed  Google Scholar 

  19. Sinha A, Singh VK, Cruise M (2014) Abdominal CT predictors of fibrosis in patients with chronic pancreatitis undergoing surgery. Eur Radiol . doi:10.1007/s00330-014-3526-x

    PubMed  Google Scholar 

  20. Bellin MD, Blondet JJ, Beilman GJ, et al. (2010) Predicting islet yield in pediatric patients undergoing pancreatectomy and auto islet transplantation for chronic pancreatitis. Pediatr Diabetes 11(4):227–234. doi:10.1111/j.1399-5448.2009.00575.x

    Article  CAS  PubMed  Google Scholar 

  21. Radomski M, Zureikat AH (2015) Total pancreatectomy and islet cell autotransplantation: outcomes, controversies and new techniques. JOP 16(1):1–10. doi:10.6092/1590-8577/2892

    PubMed  Google Scholar 

  22. Mortele KJ, Lemmerling M, de Hemptinne B, et al. (2000) Postoperative findings following the Whipple procedure: determination of prevalence and morphologic abdominal CT features. Eur Radiol 10(1):123–128

    Article  CAS  PubMed  Google Scholar 

  23. Bluemke DA, Abrams RA, Yeo CJ, Cameron JL, Fishman EK (1997) Recurrent pancreatic adenocarcinoma: spiral CT evaluation following the Whipple procedure. Radiographics 17(2):303–313. doi:10.1148/radiographics.17.2.9084073

    Article  CAS  PubMed  Google Scholar 

  24. Scialpi M, Scaglione M, Volterrani L, et al. (2005) Imaging evaluation of post pancreatic surgery. Eur J Radiol 53(3):417–424. doi:10.1016/j.ejrad.2004.12.013

    Article  PubMed  Google Scholar 

  25. Lundqvist E, Segelsjo M, Andersson A, Magnusson A, Biglarnia AR (2012) Measurement of transplanted pancreatic volume using computed tomography: reliability by intra- and inter-observer variability. Acta Radiol 53(9):966–972. doi:10.1258/ar.2012.120317

    Article  PubMed  Google Scholar 

  26. Sakata N, Egawa S, Rikiyama T, et al. (2011) Computed tomography reflected endocrine function of the pancreas. J Gastroint Surg 15(3):525–532. doi:10.1007/s11605-010-1406-5

    Article  Google Scholar 

  27. Johnson PT, Curry CA, Urban BA, Fishman EK (2002) Spiral CT following the Whipple procedure: distinguishing normal postoperative findings from complications. J Comput Assist Tomogr 26(6):956–961

    Article  PubMed  Google Scholar 

  28. Raman SP, Horton KM, Cameron JL, Fishman EK (2013) CT after pancreaticoduodenectomy: spectrum of normal findings and complications. AJR Am J Roentgenol 201(1):2–13. doi:10.2214/ajr.12.9647

    Article  PubMed  Google Scholar 

  29. Winter JM, Cameron JL, Yeo CJ, et al. (2008) Duodenojejunostomy leaks after pancreaticoduodenectomy. J Gastrointest Surg 12(2):263–269. doi:10.1007/s11605-007-0370-1

    Article  PubMed  Google Scholar 

  30. Coombs RJ, Zeiss J, Howard JM, Thomford NR, Merrick HW (1990) CT of the abdomen after the Whipple procedure: value in depicting postoperative anatomy, surgical complications, and tumor recurrence. AJR Am J Roentgenol 154(5):1011–1014. doi:10.2214/ajr.154.5.2108534

    Article  CAS  PubMed  Google Scholar 

  31. Antolovic D, Koch M, Galindo L, et al. (2007) Hepaticojejunostomy—analysis of risk factors for postoperative bile leaks and surgical complications. J Gastrointest Surg 11(5):555–561. doi:10.1007/s11605-007-0166-3

    Article  PubMed  Google Scholar 

  32. Young SA, Sfakianakis GN, Pyrsopoulos N, Nishida S (2003) Hepatobiliary scintigraphy in liver transplant patients: the “blind end sign” and its differentiation from bile leak. Clin Nucl Med 28(8):638–642. doi:10.1097/01.rlu.0000079386.99870.3f

    PubMed  Google Scholar 

  33. Zinger A, Leibowitz G (2013) Islet transplantation in type 1 diabetes: hype, hope and reality—a clinician’s perspective. Diabetes Metab Res Rev. doi:10.1002/dmrr.2484

    Google Scholar 

  34. Ahmad SA, Lowy AM, Wray CJ, et al. (2005) Factors associated with insulin and narcotic independence after islet autotransplantation in patients with severe chronic pancreatitis. J Am Coll Surg 201(5):680–687. doi:10.1016/j.jamcollsurg.2005.06.268

    Article  PubMed  Google Scholar 

  35. Chan LP, Gee R, Keogh C, Munk PL (2003) Imaging features of fat necrosis. AJR Am J Roentgenol 181(4):955–959. doi:10.2214/ajr.181.4.1810955

    Article  PubMed  Google Scholar 

  36. Kamal A, Singh VK, Akshintala VS, et al. (2014) CT and MRI assessment of symptomatic organized pancreatic fluid collections and pancreatic duct disruption: an interreader variability study using the revised Atlanta classification 2012. Abdom Imaging. doi:10.1007/s00261-014-0303-x

    Google Scholar 

  37. Cieszanowski A, Stadnik A, Lezak A, et al. (2013) Detection of active bile leak with Gd-EOB-DTPA enhanced MR cholangiography: comparison of 20-25 min delayed and 60-180 min delayed images. Eur J Radiol 82(12):2176–2182. doi:10.1016/j.ejrad.2013.08.021

    Article  PubMed  Google Scholar 

  38. Thompson CM, Saad NE, Quazi RR, et al. (2013) Management of iatrogenic bile duct injuries: role of the interventional radiologist. Radiographics 33(1):117–134. doi:10.1148/rg.331125044

    Article  PubMed  Google Scholar 

  39. Sutherland DE, Radosevich DM, Bellin MD, et al. (2012) Total pancreatectomy and islet autotransplantation for chronic pancreatitis. J Am Coll Surg 214(4):409–424 (discussion 424-406). doi:10.1016/j.jamcollsurg.2011.12.040

    Article  PubMed Central  PubMed  Google Scholar 

  40. Balachandran P, Sikora SS, Raghavendra Rao RV, et al. (2004) Haemorrhagic complications of pancreaticoduodenectomy. ANZ J Surg 74(11):945–950. doi:10.1111/j.1445-1433.2004.03212.x

    Article  PubMed  Google Scholar 

  41. Rumstadt B, Schwab M, Korth P, Samman M, Trede M (1998) Hemorrhage after pancreatoduodenectomy. Ann Surg 227(2):236–241

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  42. Thakker RV, Gajjar B, Wilkins RA, Levi AJ (1983) Embolisation of gastroduodenal artery aneurysm caused by chronic pancreatitis. Gut 24(11):1094–1098

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  43. Otah E, Cushin BJ, Rozenblit GN, et al. (2002) Visceral artery pseudoaneurysms following pancreatoduodenectomy. Arch Surg 137(1):55–59

    Article  PubMed  Google Scholar 

  44. Lake ST, Johnson PT, Kawamoto S, Hruban RH, Fishman EK (2012) CT of splenosis: patterns and pitfalls. AJR Am J Roentgenol 199(6):W686–693. doi:10.2214/ajr.11.7896

    Article  PubMed  Google Scholar 

  45. Fremont RD, Rice TW (2007) Splenosis: a review. South Med J 100(6):589–593

    Article  PubMed  Google Scholar 

  46. Sutherland DE, Gruessner AC, Carlson AM, et al. (2008) Islet autotransplant outcomes after total pancreatectomy: a contrast to islet allograft outcomes. Transplantation 86(12):1799–1802. doi:10.1097/TP.0b013e31819143ec

    Article  PubMed  Google Scholar 

  47. Dixon S, Tapping CR, Walker JN, et al. (2012) The role of interventional radiology and imaging in pancreatic islet cell transplantation. Clin Radiol 67(9):923–931. doi:10.1016/j.crad.2012.02.003

    Article  CAS  PubMed  Google Scholar 

  48. Khan KM, Desai CS, Kalb B, et al. (2013) MRI prediction of islet yield for autologous transplantation after total pancreatectomy for chronic pancreatitis. Dig Dis Sci 58(4):1116–1124. doi:10.1007/s10620-012-2448-1

    Article  PubMed  Google Scholar 

  49. Smith SL, Hampson F, Duxbury M, Rae DM, Sinclair MT (2008) Computed tomography after radical pancreaticoduodenectomy (Whipple’s procedure). Clin Radiol 63(8):921–928. doi:10.1016/j.crad.2007.10.012

    Article  CAS  PubMed  Google Scholar 

  50. Villiger P, Ryan EA, Owen R, et al. (2005) Prevention of bleeding after islet transplantation: lessons learned from a multivariate analysis of 132 cases at a single institution. Am J Transplant 5(12):2992–2998. doi:10.1111/j.1600-6143.2005.01108.x

    Article  CAS  PubMed  Google Scholar 

  51. Ryan EA, Paty BW, Senior PA, et al. (2005) Five-year follow-up after clinical islet transplantation. Diabetes 54(7):2060–2069

    Article  CAS  PubMed  Google Scholar 

  52. Shapiro AM, Lakey JR, Ryan EA, et al. (2000) Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 343(4):230–238. doi:10.1056/nejm200007273430401

    Article  CAS  PubMed  Google Scholar 

  53. Ong SL, Pollard C, Rees Y, et al. (2008) Ultrasound changes within the liver after total pancreatectomy and intrahepatic islet cell autotransplantation. Transplantation 85(12):1773–1777. doi:10.1097/TP.0b013e31817348d6

    Article  PubMed  Google Scholar 

  54. Bhargava R, Senior PA, Ackerman TE, et al. (2004) Prevalence of hepatic steatosis after islet transplantation and its relation to graft function. Diabetes 53(5):1311–1317

    Article  CAS  PubMed  Google Scholar 

  55. Jackson S, Mager DR, Bhargava R, et al. (2013) Long-term follow-up of hepatic ultrasound findings in subjects with magnetic resonance imaging defined hepatic steatosis following clinical islet transplantation: a case-control study. Islets 5(1):16–21. doi:10.4161/isl.24058

    Article  PubMed Central  PubMed  Google Scholar 

  56. Markmann JF, Rosen M, Siegelman ES, et al. (2003) Magnetic resonance-defined periportal steatosis following intraportal islet transplantation: a functional footprint of islet graft survival? Diabetes 52(7):1591–1594

    Article  CAS  PubMed  Google Scholar 

  57. Eckhard M, Lommel D, Hackstein N, et al. (2004) Disseminated periportal fatty degeneration after allogeneic intraportal islet transplantation in a patient with type 1 diabetes mellitus: a case report. Transplant Proc 36(4):1111–1116. doi:10.1016/j.transproceed.2004.04.047

    Article  CAS  PubMed  Google Scholar 

  58. Medarova Z, Moore A (2009) MRI as a tool to monitor islet transplantation. Nat Rev Endocrinol 5(8):444–452. doi:10.1038/nrendo.2009.130

    Article  PubMed  Google Scholar 

  59. Medarova Z, Moore A (2008) Non-invasive detection of transplanted pancreatic islets. Diabetes Obes Metab 10(Suppl 4):88–97. doi:10.1111/j.1463-1326.2008.00942.x

    Article  PubMed Central  PubMed  Google Scholar 

  60. Paty BW, Bonner-Weir S, Laughlin MR, McEwan AJ, Shapiro AM (2004) Toward development of imaging modalities for islets after transplantation: insights from the National Institutes of Health Workshop on Beta Cell Imaging. Transplantation 77(8):1133–1137

    Article  PubMed  Google Scholar 

  61. Eich T, Eriksson O, Lundgren T (2007) Visualization of early engraftment in clinical islet transplantation by positron-emission tomography. N Engl J Med 356(26):2754–2755. doi:10.1056/NEJMc070201

    Article  CAS  PubMed  Google Scholar 

  62. Fottner C, Mettler E, Goetz M, et al. (2010) In vivo molecular imaging of somatostatin receptors in pancreatic islet cells and neuroendocrine tumors by miniaturized confocal laser-scanning fluorescence microscopy. Endocrinology 151(5):2179–2188. doi:10.1210/en.2009-1313

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA

    Maera Haider, Elliot K. Fishman & Atif Zaheer

  2. Department of Surgery, Johns Hopkins Hospital, Halsted 610, Baltimore, MD, 21287, USA

    Martin A. Makary & Kenzo Hirose

  3. Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA

    Vikesh K. Singh & Atif Zaheer

  4. Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA

    Vikesh K. Singh

  5. 601 N. Caroline Street, JHOC 3235 A, Baltimore, MD, 21287, USA

    Atif Zaheer

Authors
  1. Maera Haider
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin A. Makary
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vikesh K. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenzo Hirose
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elliot K. Fishman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atif Zaheer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Atif Zaheer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haider, M., Makary, M.A., Singh, V.K. et al. Total pancreatectomy and islet autotransplantation for chronic pancreatitis: spectrum of postoperative CT findings. Abdom Imaging 40, 2411–2423 (2015). https://doi.org/10.1007/s00261-015-0479-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-015-0479-8

Keywords

Search

Navigation