The remaining pancreas is often atrophic, and mild dilatation of the pancreatic duct is common. A soft tissue defect at the pancreaticojejunostomy site may be seen secondary to invagination of the pancreas into the bowel loop (the so-called dunking procedure) and may simulate tumor recurrence or intussusception. Bluemke et al. reported thickening of the gastric antrum and proximal duodenum in 64% of patients undergoing the pylorus-preserving Whipple procedure with adjuvant chemotherapy and radiation therapy. These findings were thought to be secondary to the radiation therapy and should not be attributed to metastatic disease. The most common complication and the leading cause of perioperative mortality following the Whipple procedure is related to leakage or breakdown of the pancreaticojejunostomy. Unfortunately, this anastomosis is the most difficult to visualize with contrast. Trerotola et al. have suggested a preferred method of fluoroscopic visualization of this region by injection of the biliary stent or T tube in a shallow Trendelenburg or left posterior oblique position.
“radiology images of Supine film from an upper GI” series showing a defect at the pancreaticojejunostomy site from invagination of the pancreas into the bowel.
X Ray with contrast of Whipple procedure with dunking
4/ 5Oleh Habifa