Imaging after a whipple operation: improving visibility of the afferent jejunal loop in spiral computed tomography using biliary contrast medium.
OBJECTIVE
Spiral computed tomography (CT) examination of patients after a Whipple operation often raises questions concerning the afferent loop. This study evaluates the efficiency of biliary contrast medium (BCM) in visualizing opacification of this loop.


METHODS
After undergoing a Whipple operation, 31 patients received 100 mL BCM before postoperative spiral CT (Somatom Plus 4; Siemens, Erlangen, Germany: 5- or 10-mm slices, feed of 7 or 12 mm/s; Volume Zoom; Siemens: 2.5 mm collimation, total feed of 15 mm/s). Semiquantitative evaluation included opacification of the jejunal loop and visibility of jejunostomies. Complications and tumor recurrences were recorded.


RESULTS
In all patients, BCM was successfully administered without complications. Afferent loop opacification was seen in 95% of examinations with BCM versus 5% of examinations with oral contrast medium. Evaluation of jejunostomies was unequivocally facilitated by BCM. Three previously undetermined changes were identified as tumor recurrence, and recurrence was ruled out after examination with BCM in 7 cases.


CONCLUSIONS
After a Whipple operation, opacification of the afferent loop can be regularly achieved by intravenous administration of BCM, which eases distinction of normal postoperative changes from local tumor recurrence. Administration of BCM is recommended as a standard diagnostic procedure in these patients.
Stumpp
Patrick
P
Department of Diagnostic Radiology, University of Leipzig, Leipzig, Germany. stup@medizin.uni-leipzig.de
Klöppel
Rainer
R
Kahn
Thomas
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract; D002768:Choledochostomy; D003287:Contrast Media; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D005774:Gastrostomy; D006801:Humans; D007583:Jejunum / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed
D003287:Contrast Media