Purpose or Case Report: In this exhibit we will describe a fairly new surgical procedure - total pancreatectomy and islet autotransplant (TPIAT). TPIAT is an uncommon procedure performed in children who suffer from chronic or recurrent acute pancreatitis. The purpose of the exhibit is to learn about the selection criteria, the surgery itself, and the imaging features of surgical complications.

Candidates are selected for surgery based on a multitude of factors including severity and chronicity of pain, laboratory evaluation of pancreatic exocrine and endocrine function, and imaging features of chronic pancreatitis on MRCP and/or endoscopic ultrasound.

In the surgical procedure, the pancreas and duodenum are resected, islet cells are isolated and then infused through the portal vein into the liver. A splenectomy is performed and continuity of the GI tract restored. Patients may spend three weeks in the hospital after surgery. Months after the infusion, the islet cells will be embedded within the liver and begin to produce insulin.

The primary goal of this procedure is to relieve debilitating pain and improve quality of life, for which this procedure is around 90% successful. The secondary goal of the procedure is to retain islet cell function. In this regard, approximately 40% of the pediatric patients will regain complete islet cell function, 30% will regain partial function while 30% will have no islet cell function.

Follow up imaging may also be performed on these patients for evaluation of complications such as delayed gastric emptying, small bowel obstruction, surgical site infections, bile leak, and intra-abdominal hemorrhage. Complications seen in our hospital, including small bowel obstruction, delayed gastric emptying, and prolonged ileus will be highlighted.

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