Niccolo Faccioli MD, Presenter: Nothing to Disclose

Alessio Comai MD, Abstract Co-Author: Nothing to Disclose

Farah Moore, Abstract Co-Author: Nothing to Disclose

Mirko D'Onofrio MD, Abstract Co-Author: Nothing to Disclose

Roberto Pozzi Mucelli, Abstract Co-Author: Nothing to Disclose

To describe the radiological features of post-operative pancreatic fistula (PF) after pancreaticoduodenectomy (PD) and their correlation with the clinical impact.

A retrospective study was performed on the fistulogram carried out for clinical suspicion to PF after PD. Out of a total of 380 PDs performed from 2001 to 2005, 56 fistulogram were found. PF was clinically defined according to the international study group (ISGPF) as Grade A, B and C. Fistulograms were performed only on patients with important clinical impact of PF (Grade B and C) or with suspect of drain migration into an intestinal loop. We correlated the results of fistulography (incidence and site of PF, occurrence of fluid collection, communication with main pancreatic duct, biliary tree and jejunal loop and presence of drain into the jejunal loop or stomach) with the clinical suspicion of PF.

Forty-two out of 56 Patients (75%) had PF confirmed by fistulogram. We visualized 29 communications with the jejunal loop, 8 with the jejunal loop and the biliary tree, 12 with the main pancreatic duct and 9 with the stomach. In 14 Patients (25%) the drain was abnormally placed inside the jejunal loop or stomach: in all these cases, once the drain was mobilized, the complication resolved within 72 hours.

Fistulogram help in the confirmation of clinical suspected of PF decreasing post-operative morbidity and re-operation rate. Fistulogram is crucial in distinguishing cases of gastro-intestinal fistula due to the migration of the drain into an intestinal loop.

Fistulography can help in the management of Patients with clinical suspicion of postoperative pancreatic fistulas.

Faccioli, N, Comai, A, Moore, F, D'Onofrio, M, Pozzi Mucelli, R, Role of Fistulography in Postoperative Pancreatic Fistulas.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5004694.html