Pancreatic Fistula after Pancreaticoduodenectomy: Role of Fistulography

Faccioli N¹, Molinari E¹, Perandini S¹, Bassi C², Pozzi Mucelli R¹

Departments of ¹Radiologyand ²Surgery, G.B. Rossi Hospital, University of Verona. Verona, Italy

ABSTRACT

Context Pancreatic fistula (PF) is the most frequent complication of PD. To our knowledge, no studies in the radiology literature have ever focused attention on the value of fistulography on patients after pancreatic surgery. Aim To prospectively evaluate with fistulography the radiological features of post-operative pancreatic fistula (PF) after pancreaticoduodenectomy (PD) in correlation with the clinical findings. Methods A prospective study was performed on the fistulograms carried out for clinical suspicion of PF after PD. Out of a total of 427 PDs performed from 2001 to 2007, 84 fistulograms were carried out. PF was clinically defined according to the international study group (ISGPF). Fistulographies permitted to determine: the site of the distal portion of the drainage, the presence or absence of connection with jejunal loop or stomach, the presence or absence of fistulous tract or fluid collections, the presence or absence of connection with the main pancreatic duct, and or the biliary tree. Results Forty-nine out of 84 patients (58,3%) had PF confirmed by fistulography. In 35 patients (41.6%) the drainage was abnormally placed inside the jejunal loop or stomach: in all these cases, once the drainage was mobilized, the complication resolved within 72 hours. The most important factor to distinguish the two pathological entities was the presence or absence of fistulous tract. Conclusion Fistulography helps in the confirmation of clinical suspect of PF decreasing post-operative morbidity and re-operation rate, and is crucial in distinguishing PF from fistulas due to the migration of the drainage into an intestinal structure.

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