Holm Tara,  Murati Michael,  Hoggard Eric,  Dietz Kelly

Final Pr. ID: Poster #: SCI-014

Total pancreatectomy and islet autotransplantation (TPIAT) has become an increasingly utilized option for pain management in pediatric patients with chronic and hereditary pancreatitis. Doppler ultrasound of the liver is routinely used to evaluate patency of the portal vein and assess portal vein and hepatic artery velocities after this procedure. However, to the best of our knowledge no study has established the expected Doppler findings on pediatric patients after TPIAT. This study is intended to establish normal values for velocities in the hepatic artery and portal vein in pediatric patients after TPIAT, and to determine the rate of hepatic vascular complications in these patients. Read More

Authors:  Holm Tara , Murati Michael , Hoggard Eric , Dietz Kelly

Keywords:  Islet Autotransplantation, pancreatitis, Doppler

Ames Jeff,  Holm Tara,  Murati Michael,  Hoggard Eric,  Dietz Kelly

Final Pr. ID: Poster #: EDU-025

Chronic pancreatitis (CP) is characterized by permanent damage to the pancreas resulting in endocrine and exocrine deficiencies. CP is often associated with a history of acute recurrent pancreatitis. Pediatric CP is most commonly linked to known genetic mutations, such as PRSS1 or CFTR, and there is an increased risk of pancreatic adenocarcinoma in patients with hereditary pancreatitis. The mainstay of CP management involves controlling chronic pain and preserving quality of life.

Total pancreatectomy and islet auto-transplantation (TPIAT) is an option for managing pain in pediatric patients with uncontrollable pain or pancreatitis secondary to genetic causes. TPIAT was first performed at the University of Minnesota in 1971. Currently there are more than 15 academic institutions in the US performing TPIAT and that number continues to rise. TPIAT has been shown to be effective for pain relief as well as maintaining insulin independence in adults and young pediatric patients. The timing of TPIAT in a patient’s disease course is critical because islet cell yield is inversely correlated with pancreatic fibrosis, and postoperative diabetes outcomes depend on islet yield.

Imaging prior to transplant is aimed at assessing changes of pancreatitis, vessel patency, and identifying vessel and pancreatic ductal anatomic variants. Preoperative imaging can also confirm adequate liver volume for the procedure and identify postoperative changes from previous procedures such as distal pancreatectomy or Puestow procedure (pancreaticojejunostomy).

Routine postoperative imaging consists of liver Doppler ultrasound screening because elevated infusion pressures during autotransplantation can result in endothelial injury and portal vein thrombosis. Delayed gastric emptying and small bowel ileus are common postsurgical complications, and targeted cross-sectional imaging, radiography, and fluoroscopy may be performed based on patient symptoms. Once bowel function has returned, enteral feeds are started via gastrojejunostomy tube and can sometimes be complicated by GJ tube-related intussusception. The largest retrospective review in pediatric patients showed a 20% surgical complication rate, with the most common complication being post-splenectomy thrombocytosis.

We present pertinent imaging findings for surgical planning in patients with CP prior to TPIAT, expected postoperative imaging findings, and imaging of postoperative complications. Read More

Authors:  Ames Jeff , Holm Tara , Murati Michael , Hoggard Eric , Dietz Kelly

Keywords:  Chronic pancreatitis, Islet autotransplant, Total pancreatectomy

Richardson Rebecca,  Morin Cara,  Wheeler Charles,  Karol Seth,  Jeha Sima,  Inaba Hiroto,  Mccarville Beth

Final Pr. ID: Poster #: SCI-019

Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Children with ALL are at risk for developing acute pancreatitis (AP) during treatment, most commonly related to asparaginase. According to the American College of Radiology guidelines, ultrasound (US) should be the first line imaging modality in the diagnosis of AP. However, AP in children with ALL is thought to be due to direct pancreatic injury rather than ductal obstruction, and thus US may not be the optimal imaging modality for this diagnosis. Read More

Authors:  Richardson Rebecca , Morin Cara , Wheeler Charles , Karol Seth , Jeha Sima , Inaba Hiroto , Mccarville Beth

Keywords:  pancreatitis, ALL, ultrasound