History of cholangiohepatitis with known biliary stricture. History of hepatolithiasis status post left hepatic resection at outside hospital. Recurrent stone formation. Presents with abdominal pain and nausea. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from left hepatectomy and cholecystectomy.There is apparent persistence of the hepatic-gastric cardia fistula as seen on the ERCP dated 8/13/2015 (series 7/11) at the level of the proximal common hepatic duct/confluence of the right hepatic duct. There is narrowing at the confluence of the right hepatic ducts with mild intrahepatic biliary ductal dilatation, a narrow smooth short segment stricture of the proximal common hepatic duct measuring 1.9 cm in length (series 9/2) and an approximately 1.4 cm stricture of the distal common hepatic duct at the level of the head of the pancreas. Proximally the common duct measures 8 mm in caliber. Overall the morphology of the biliary duct system is unchanged from the prior study.No focal lesion or abnormal postcontrast enhancement. No hepatolithiasis or choledocholithiasis.Subcentimeter punctate arterial enhancing focus at the dome of the liver is unchanged and likely represents a flash filling hemangioma.Suspected artifact at the orifice of the right hepatic vein. The vessels are otherwise patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.No significant change in the morphology of the biliary ductal system including focal stenosis at Klatskin's point, short focal stricture of the proximal common hepatic duct and short focal stricture at the level of the head of the pancreas.2.Persistent fistulous communication between the proximal common duct and the gastric cardia.3.No suspicious hepatic lesion, hepatolithiasis or choledocholithiasis.