D'Alessandro C, Todisco M, Di Bella C, Crimì F, Furian L, Quaia E, Vernuccio F. Surgical complications after pancreatic transplantation: A computed tomography imaging pictorial review. World J Gastroenterol 2023; 29(46): 6049-6059 [PMID: 38130739 DOI: 10.3748/wjg.v29.i46.6049]
Corresponding Author of This Article
Federica Vernuccio, DPhil, Associate Professor, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, Palermo 90127, Italy. federicavernuccio@gmail.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 14, 2023; 29(46): 6049-6059 Published online Dec 14, 2023. doi: 10.3748/wjg.v29.i46.6049
Surgical complications after pancreatic transplantation: A computed tomography imaging pictorial review
Carlo D'Alessandro, Matteo Todisco, Caterina Di Bella, Filippo Crimì, Lucrezia Furian, Emilio Quaia, Federica Vernuccio
Carlo D'Alessandro, Filippo Crimì, Emilio Quaia, Department of Radiology, University of Padova, Padova 35128, Italy
Matteo Todisco, Department of Radiology 2, University Hospital of Padova, Padova 35128, Italy
Caterina Di Bella, Department of Surgical, Kidney and Pancreas Transplantation Unit, Padova 35128, Italy
Lucrezia Furian, Kidney and Pancreas Transplantation Unit, University of Padua, Padova 35128, Italy
Federica Vernuccio, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo 90127, Italy
Federica Vernuccio, Department of Radiology, University Hospital of Padova, Padova 35128, Italy
Author contributions: D'Alessandro C, made the literature search, wrote the first draft of the manuscript, and prepared most of the figures; Todisco M conceptualized the manuscript, helped with figures preparation and provided inputs; Di Bella C and Furian L wrote the first draft of the manuscript for the surgical paragraph, provided inputs and revised the draft of the manuscript; Crimì F provided inputs and revised the draft of the manuscript; Quaia E conceptualized the manuscript, provided inputs, and revised the draft of the manuscript; Vernuccio F conceptualized the manuscript, helped with the literature search, wrote the outline of the manuscript, prepared some of the figures and extensively revised the draft of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Federica Vernuccio, DPhil, Associate Professor, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, Palermo 90127, Italy. federicavernuccio@gmail.com
Received: August 3, 2023 Peer-review started: August 3, 2023 First decision: October 9, 2023 Revised: October 25, 2023 Accepted: November 27, 2023 Article in press: November 27, 2023 Published online: December 14, 2023
Abstract
Pancreatic transplantation is considered by the American Diabetes Association and the European Association for the Study of Diabetes an acceptable surgical procedure in patients with type 1 diabetes also undergoing kidney transplantation in pre-final or end-stage renal disease if no contraindications are present. Pancreatic transplantation, however, is a complex surgical procedure and may lead to a range of postoperative complications that can significantly impact graft function and patient outcomes. Postoperative computed tomography (CT) is often adopted to evaluate perfusion of the transplanted pancreas, identify complications and as a guide for interventional radiology procedures. CT assessment after pancreatic transplantation should start with the evaluation of the arterial Y-graft, the venous anastomosis and the duodenojejunostomy. With regard to complications, CT allows for the identification of vascular complications, such as thrombosis or stenosis of blood vessels supplying the graft, the detection of pancreatic fluid collections, including pseudocysts, abscesses, or leaks, the assessment of bowel complications (anastomotic leaks, ileus or obstruction), and the identification of bleeding. The aim of this pictorial review is to illustrate CT findings of surgical-related complications after pancreatic transplantation. The knowledge of surgical techniques is of key importance to understand postoperative anatomic changes and imaging evaluation. Therefore, we first provide a short summary of the main techniques of pancreatic transplantation. Then, we provide a practical imaging approach to pancreatic transplantation and its complications providing tips and tricks for the prompt imaging diagnosis on CT.
Core Tip: Pancreatic transplantation is a complex surgical procedure and, similarly to any major surgical intervention, may lead to a range of postoperative complications that can significantly impact graft function and patient outcomes. Computed tomography offers non-invasive and accurate visualization of the transplanted pancreas and surrounding structures, providing detailed anatomical information and aiding in the detection of complications.
