Postoperative Anatomy
What to know
Postoperative anatomy changes normal landmarks. After cholecystectomy the gallbladder is absent, surgical clips mark the fossa, and a small fluid collection may be normal; a bile leak or abscess is a complication. A Whipple resection removes the pancreatic head and duodenum and creates pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy anastomoses-know the expected bowel and ductal connections before calling a fluid collection abnormal.
After liver transplantation, document hepatic artery patency with Doppler, since hepatic artery thrombosis is a graft-threatening emergency; also assess the portal vein anastomosis, biliary anastomosis for stricture or leak, and perihepatic collections. After nephrectomy the renal fossa fills with bowel and the contralateral kidney hypertrophies. Bariatric surgery-band, sleeve, or bypass-alters gastric anatomy and limits acoustic windows.
Stents, drains, and catheters create strong reflectors and comet-tail or reverberation artifacts.
Traps
Surgical clips mimic stones but show comet-tail artifact rather than clean shadowing. Postoperative fluid collections are common and often benign; correlate with fever, pain, and laboratory values. Altered anatomy invalidates usual landmark-based measurement.
Rule of thumb
After transplant, no hepatic artery flow on Doppler is an emergency until proven otherwise-verify technique and settings, then call immediately.