Abdomen after a Puestow procedure: postoperative CT appearance, complications, and potential pitfalls

To evaluate the postoperative computed tomographic (CT) appearance, complications, and potential pitfalls after a Puestow procedure (lateral side-to-side pancreaticojejunostomy).

Forty CT examinations were performed after the Puestow procedure in 20 patients. Images were retrospectively reviewed by three radiologists.

The pancreaticojejunal anastomosis was identified at 30 examinations and was immediately anterior to the pancreatic body or tail. The anastomosis contained fluid or gas on 11 scans and oral contrast material on four scans. On 15 scans, the anastomosis appeared as collapsed bowel without gas, fluid, or oral contrast material. The Roux-en-Y loop was identified on 28 (70%) scans and contained fluid or gas on 16 scans and oral contrast material on six scans. The Roux-en-Y loop appeared as collapsed bowel on six scans. When the anastomosis or Roux-en-Y loop contained fluid and gas, the appearance mimicked that of a pancreatic or parapancreatic abscess. Peripancreatic stranding was present on 28 scans and was due to either ongoing pancreatitis or postoperative change. Complications included 15 transient fluid collections, three abscesses, four pseudocysts, one hematoma, and one small-bowel and Roux-en-Y obstruction.

Knowledge of the anatomy after a Puestow procedure is essential for accurate interpretation of CT scans.