History of pancreas divisum status post partial gastrectomy/Bilroth 2 in May 2015 for perforated gastric ulcer, complicated by acute pancreatitis and pancreatico-cutaneous fistula status post IR drainage. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size, measuring 18.7 cm in the craniocaudal dimension. It is normal in signal intensity. No discrete lesion is evident.Demonstrated again is marked extrahepatic biliary ductal dilatation measuring 2.1 cm (series 5 image 1), with moderate intrahepatic biliary ductal dilatation, appearing similar to the prior study. The common bile duct tapers smoothly at the level of the ampulla without an obstructing stone or mass evident. Distended gallbladder without acute inflammation. Probable small gallstone.SPLEEN: No significant abnormality noted.PANCREAS: Internal drainage catheter appears to extend from the main pancreatic duct into the gastric lumen. The main pancreatic duct is irregularly dilated up to 8 mm (series 4/17), not significantly changed from the prior study. The previously seen focal narrowing at the pancreatic body tail junction has improved.Again it appears that the main pancreatic duct merges with a smaller duct in the uncinate process which extends anteriorly and enters the more proximal duodenum at the expected location of the minor papilla. It also communicates with a complex fistula deep to the ventral incision site where there is a 2.3 x 1.1 cm fluid collection (series 4/22) draining into the ventral soft tissues, new from the prior.There is moderate parenchymal atrophy and decreased intrinsic T1 signal intensity and postcontrast enhancement of the pancreatic parenchyma compatible with parenchymal dysfunction.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Tortuous abdominal aorta with infrarenal aneurysmal dilatation better evaluated on prior CT.BOWEL, MESENTERY: Postsurgical changes from a Billroth II procedure.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Stable marked extrahepatic and moderate intrahepatic biliary ductal dilatation to the level of the ampulla without a discrete stone or obstructing mass evident.2.Irregular beaded appearance of the pancreatic duct is likely related to chronic pancreatitis. The main pancreatic duct again appears to communicate with a smaller duct in the uncinate process and extends anteriorly where it appears to drain into the more proximal duodenum at the minor papilla and communicates with the complex fistulous tract now associated with a new 2.3 cm fluid collection which drains into the ventral incision, consistent with a pancreatico-cutaneous fistula. 