History of cholecystectomy and vertical banding gastroplasty with postprandial epigastric pain. Endoscopic ultrasound findings suggestive of benign ampullary stenosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity, size and enhancement. There is significant extrahepatic and moderate intrahepatic diffuse biliary ductal dilatation to the level just proximal to the ampulla. The common bile duct measures up to 13 mm (series 10/26). No focal liver lesion. The vessels are patent.Status post cholecystectomy.SPLEEN: The spleen is normal in morphology and size.PANCREAS: The pancreas is normal in morphology and enhancement. There are several punctate pancreatic tail subcentimeter cystic foci which appear to communicate with the main pancreatic duct likely representing side branch type IPMNs. The main pancreatic duct is dilated up to 7 mm to the level just proximal to the ampulla where both the main pancreatic duct and common bile duct taper abruptly with mild shouldering (series 5 image 75). Postcontrast images demonstrate very subtle irregularly marginated enhancing focus at the ductal transition point (series 14 image 156 through 161). There is no significant distal pancreatic parenchymal atrophy. Following secretin administration there is no significant caliber change in the main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right minimally complex septated cyst. No hydroureteronephrosis or suspicious lesion. Punctate left renal probable simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical changes from vertical banding gastroplasty. BONES, SOFT TISSUES: L1 hemangioma.OTHER: No significant abnormality noted.
Biliary and main pancreatic ductal dilatation to the level just proximal to the ampulla where there is a subtle subcentimeter irregularly marginated focus of enhancement, suspicious for an underlying obstructive lesion. Correlation with repeat ERCP/EUS is advised.