 To demonstrate the role of computed tomography (CT) to evaluate post-operative anatomy and normal changes after Whipple procedure (WP).  To acquire basic knowledge and comprehension of the surgical technique of Whipple procedure.  List the common complications we had found along 3 years and describe the different appearance of them after WP.  To identify and describe signs of recurrent neoplasm according to the postoperative time in each case.  To follow up the appearance changes of different structures after a Whipple procedure beyond a month.

 Whipple procedure is the most often treatment for the pancreatic adenocarcinoma, which is a devastating disease (with a 3-year survival rate of approximately 2%). However, patients with small tumors (< 2 cm) limited to the head of the pancreas who undergo Whipple procedure have substantially improved rates of survival (30% at 5 years).  CT examination of patients who have undergone a Whipple procedure is complex.  Interpretation of the CT scans depends on an understanding of the normal postoperative appearance, potential complications, and patterns of recurrent disease.

RESECTION OF:  Pancreas head and the uncinate process  Gallbladder and the common bile duct  Duodenum  Subtotal gastrectomy and the pylorus

ANASTOMOSES : 1.Pancreatojejunostomy (Termino-Lateral):  Join remanent pancreas (the body) with the jejunum proximal (which follows to the Treiz). 2.Biliojejunostomy (termino-lateral):  Join remaining bile duct (common hepatic duct) with the same jejunum which follows after pancreatojejunostomy.  This loop of jejunum, is called biliopancreatic loop.

3.Gastrojejunostomy (Termino-Lateral):  Join remanent gastric with a loop of jejunum, which has been brought up to the left upper quadrant crossing the transverse mesocolon. This loop of jejunum is called alimentary loop. 4.Enteroenteric Anastomosis (Latero-Lateral):  Join both, biliopancreatic loop and alimentary loop, which coming from right and left upper quadrants. This join is located in mesogastric area (inferior and posterior to the transverse colon).

3º LYNPHADENECTOMY 2º COMMON BILE DUCT SECTION 1º GALLBLADDER RESECTION 4º SUBTOTAL GASTRECTOMY 5º PANCREAS SECTION AB B H E F G D C I J A: Gallbladder B: Surgical bed of gallbladder C: Common Bile Duct (both ends) D: Portal Vein E: Aorta Artery F: Inferior Cava Vein G: Proximal Gastric Pouch H: Distal Gastric Pouch Resected I: Body of the pancreas J: Head of the pancreas K: Wirsung duct