Total Pancreatectomy and Islet Autotransplantation: Imaging Findings and Complications

Total pancreatectomy and islet autotransplantation (TPIAT) is a complex surgical procedure performed in transplant centers throughout the United States, with increasing prevalence over the last 2 decades. The goals of TPIAT are to alleviate pain caused by debilitating chronic pancreatitis or acute recurrent pancreatitis by removing the pancreas and to prevent the development of brittle diabetes by infusion of pancreatic islet cells to replace the function of the surgically absent pancreas. Imaging plays a key role in evaluating patients who have undergone TPIAT. Radiologists must be aware of the surgical procedure and its variations, expected postoperative imaging findings, and potential complications for accurate diagnosis. The authors review the background of TPIAT and the indications for and goals of the procedure. The surgical procedure, expected postsurgical anatomy, imaging findings, and spectrum of complications are described. Imaging findings of postoperative complications and sequelae of TPIAT may include bowel or bile leak, anastomotic breakdown, abscess, hematoma, biliary stricture, bowel obstruction due to anastomotic stricture, adhesions, incisional or internal hernia, delayed gastric emptying, bezoar, vascular abnormalities (eg, thrombosis, pseudoaneurysm), omental infarct and/or asymptomatic fat necrosis, and atypical patterns of hepatic steatosis, including nodular hepatic steatosis. ^©RSNA, 2026.