Fluid collections developing after pancreatic transplantation: radiologic evaluation and intervention.

Abstract

The usefulness of real-time sonography, duplex sonography, computed tomography (CT), cystography, diagnostic aspiration, and percutaneous drainage in the diagnosis and treatment of peri-pancreatic-transplant fluid collections was retrospectively assessed in 46 recipients of extraperitoneal pancreatic transplants. Forty-four abnormalities were identified in the extraperitoneal space at sonography, including four pancreatic pseudocysts associated with malfunction of the pancreatic duct, seven abscesses, six hematomas, nine urinomas, six early postoperative fluid collections that spontaneously resolved, six cases of pancreatitis, and six cases of vascular occlusion. Sonography (including pulsed Doppler sonography) was the procedure of choice in detecting fluid collections and diagnosing pancreatitis, rejection, vascular thrombosis, and pancreatic duct malfunction. CT was diagnostic in four of six hematomas; cystography was diagnostic in seven of nine urinomas. Sonographically guided percutaneous intervention enabled three patients to avoid surgery and allowed optimal surgical planning for six patients.

Characterization and Impact of Wound Infection After Pancreas Transplantation

“…'1 The reported incidence of wound in¬ fection after pancreas transplantation ranges from 7% to 50%.2'4"10 Superficial and deep (ie, intra-abdominal) wound infec¬ tions occur alone or in combination, and often these represent serious complica¬ tions that may lead to allograft loss and that are associated with patient death. 6,8,11 The attendant morbidity associated with the oc¬ currence of wound infection may be, in part, a result of delayed diagnosis owing to the suppression of signs and symp¬ toms of infections that accompanies immunosuppression. '1 However, the pathogenetic factors that predispose patients to these types of infection, the source of the microbial inoculum, and the optimal See Patients and Methods on next page PATIENTS AND METHODS STUDY POPULATION From January 1, 19901, , to September 30, 1993 pa¬ tients underwent 207 consecutive whole-organ pancreas transplantation procedures at the University of Minne¬ sota.…”

Interventional Procedures in Whole Organ and Islet Cell Pancreas Transplantation

“…Imaging alone is unreliable for the characterization of these collections, and larger collections may be aspirated with US or CT guidance as appropriate. 24,25 Some peri-transplant collections may be successfully drained with conventional percutaneous catheter techniques (Figs. 4A-D) but up to 70% of these may require subsequent surgical intervention.…”

Percutaneous Aspiration and Drainage of Fluid Collections Complicating Solid Organ Transplants

“…Similarly, imaging guidance for percutaneous aspiration and drainage procedures in these settings is typically accomplished with US or CT. [1][2][3][4][5][6][7] In many instances, US guidance alone is adequate, although in some patients, particularly hepatic or intraperitoneal pancreatic recipients, at least a preliminary diagnostic CT examination with gastrointestinal opacification is useful to exclude the presence of multiple collections and to localize bowel loops that may make catheter course planning difficult. Additionally, when the location of a target collection in relation to adjacent bowel loops or vascular structures is uncertain, CT with intestinal opacification, and occasionally with intravenous enhancement, is necessary.…”

“…Methods detailed in the literature for percutaneous aspiration and drainage in this set of patients do not vary substantially from those in non-transplant patients. [1][2][3][4][5][6][7] Diagnostic aspirations are generally performed with 18-to 21-gauge needles; percutaneous aspirations are almost uniformly successful in the acquisition of diagnostic material in transplant patients. Therapeutic drainages are usually done with 6F to 14F curved, pigtail, or Cope-type abscess, biliary, or urinary catheters, typically using a Seldinger or, less commonly, a trocar technique.…”

“…In extraperitoneal grafts, a series of six therapeutic aspiration drainages produced a success rate of 50%. 7 It is difficult to conclude much from such small series, but it is possible that catheter drainage will prove more successful in extraperitoneal grafts, as infectious or inflammatory pancreatic processes may be better confined than after intraperitoneal transplantation, a setting where multisite and diffuse involvement is common.…”