CT evaluation following Whipple procedure: potential pitfalls in interpretation.

A series of 41 CT examinations in 14 patients who had undergone a Whipple procedure for pancreatic cancer followed by adjuvant chemotherapy and radiation therapy were reviewed to determine the spectrum of CT findings, as well as to identify potential sources of error in interpretation. Thickening of the wall of the gastric antrum and proximal duodenum from 5 to 10 mm (9 of 14 patients) occurred as early as 1 month after completion of radiotherapy and simulated recurrent tumor. Unopacified anastomotic bowel loops in the porta hepatis in 23 of 41 examinations (56%) also mimicked recurrent tumor or adenopathy. Five of 14 patients showed liver metastases and 4 of 14 had recurrent disease in the pancreatic bed. Pneumobilia (33 of 41 examinations) was a frequent normal finding.