History of appendiceal cancer presents for restaging. History of omental biopsy with metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Several too small to characterize punctate foci, probable cysts are unchanged. No suspicious parenchymal lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in size, signal intensity and enhancement without a focal lesion. Small splenules are noted adjacent to the anterior aspect of the spleen, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral percutaneous nephroureteral stents without hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post right hemicolectomy. Very small mesenteric lymph nodes are unchanged. Mild peritoneal surface thickening without discrete nodular enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is thickening of the peritoneal surfaces and serosal small bowel surfaces associated with mild restricted diffusion but no discrete nodular enhancement. The pelvic small bowel mesentery appears hazy.There is mild tethering of the small bowel to the level of the bladder dome without obstructive complication.In the region of the rectovesical pouch and site of patient's known seminal vesicle excision there is a 5.1 x 3.1 cm fluid pocket demonstrating restricted diffusion and wall enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. No definite measurable solid disease is seen in the abdomen or pelvis.2. Peritoneal surface and serosal bowel wall surface thickening and pelvic small bowel mesentery haziness with associated restricted diffusion but no discrete nodular enhancement. Differential includes postsurgical changes from extensive peritoneal surface stripping although residual tumor is not excluded.3. Rectovesical pouch fluid pocket with restricted diffusion and wall enhancement is favored to be postoperative although residual disease cannot be entirely excluded. If the patient has signs and symptoms of infection an infected collection should be considered.