59-year-old female with history of ampullary carcinoma status post Whipple. Now with abdominal pain and nausea. ABDOMEN:LIVER, BILIARY TRACT: No hepatic masses identified. Status post Whipple procedure. The hepaticojejunostomy is patent, though the common hepatic bile duct is irregular. The intrahepatic biliary ducts demonstrate multifocal stenoses. The gallbladder is surgically absent.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple procedure. There is a short stricture of the distal pancreatic duct at the pancreaticojejunostomy, with mild diffuse dilation of the pancreatic duct proximally. No focal pancreatic without focal mass identified. Response to secretin is identified. No peripancreatic fluid collections are present.ADRENAL GLANDS: Right adrenal adenoma. Left adrenal gland thickening.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.
1.Short stricture of the postsurgical distal pancreatic duct near the pancreaticojejunostomy, with mild diffuse dilation of the pancreatic duct proximally.2.Multifocal stenoses of the hepatic biliary system, which may represent autoimmune cholangiopathy or primary sclerosing cholangitis.3.No hepatic or pancreatic mass identified.4.Pancreatic response to secretin identified.