Pancreatic transplantation using portal venous and enteric drainage: the postoperative appearance of a new surgical procedure.

Purpose: To review the normal radiologic appearance of pancreatic transplants that use portal venous and enteric drainage, and to review the appearance of a variety of postoperative complications.
Method: We retrospectively reviewed the computed tomographic (CT) scans, magnetic resonance (MR) images, and ultrasounds of patients who had undergone pancreatic transplantation using portal venous and enteric drainage.
Results: At CT, the normal pancreatic transplant appears as a heterogeneous mass composed of pancreatic parenchyma, vessels, and omental wrap. On MR imaging, a normal transplant demonstrates intermediate signal intensity on T1- and T2-weighted sequences. Sonographic evaluation of a normal transplant reveals a hypoechoic gland that contains readily detectable low-resistance arterial and venous Doppler waveforms. Acute postoperative complications include acute rejection, which has a nonspecific radiologic appearance, and transplant pancreatitis, which is often manifested on CT by stranding of the peritransplant fat. Chronic postoperative complications include small bowel obstructions, graft pancreatitis secondary to obstruction of the Roux loop, and chronic rejection.
Conclusion: Knowledge of the radiologic appearance of the normal pancreatic transplant is required before transplant-related complications can be detected.