45-year-old man with history of pancreatic cancer status post Whipple procedure, complicated by abscess formation, status post IR drainage. Please note that this examination was slightly limited as the patient was unable to tolerate the entire examination.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. There is no significant intrahepatic biliary duct dilatation and the biliary-enteric anastomosis is intact.SPLEEN: The spleen is normal.PANCREAS: The patient is status post Whipple and, adjacent to the biliary-enteric anastomosis, there is a fluid collection with small foci of gas and layering debris now measuring 123 x 67 mm, previously 173 x 122 mm (series 5, image 37). There is no significant enhancement. A drainage catheter is noted within this collection.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Kidneys are normal in enhancement symmetrically.RETROPERITONEUM, LYMPH NODES: There are mildly prominent portocaval lymph nodes but no significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anterior and lateral abdominal wall soft tissue edema is noted.OTHER: There are additional smaller sites of loculated fluid in the mesentery and right lower quadrant more inferiorly.
Discrete, drained fluid collection adjacent to the biliary enteric anastomosis suspicious for bile leak. If confirmation of biliary leak is clinically warranted, HIDA scan should be considered. Additional smaller mesenteric and right lower quadrant collections seen more inferiorly.