History of partial gastrectomy and Billroth II complicated by pancreatico-cutaneous fistula with bile duct dilatation on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size measuring 16 cm in craniocaudal dimension.It is normal signal intensity. There is marked extrahepatic biliary ductal dilatation with the common bile duct measuring 2.1 cm with moderate intrahepatic biliary duct dilatation. The common bile duct tapers smoothly at the level of the ampulla without an obstructing stone or mass evident.Distended gallbladder without acute inflammation.Small perihepatic fluid collection adjacent to segment 6 is unchanged.SPLEEN: Normal splenic size and morphology without focal lesion.PANCREAS: The pancreatic duct is irregularly dilated up to 8 mm and narrowed, with a moderate stricture at the body tail junction. The dilated main pancreatic duct extends anteriorly and does not clearly communicate with the common bile duct which inserts into the major papilla. The main pancreatic duct appears to merge with a smaller duct in the uncinate process and extends anteriorly where it enters the more proximal duodenum at the minor papilla and communicates with the complex fistulous tract. On postcontrast imaging there is a persistent complex fistulous network deep to the incision site compatible with patient's known pancreatico-cutaneous fistula with no discrete fluid collection is evident.Moderate parenchymal atrophy with decreased intrinsic T1 signal intensity and postcontrast enhancement 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 the recent prior CT.BOWEL, MESENTERY: Postsurgical changes from Billroth procedure.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large bilateral pleural effusions with compressive atelectasis.
1.Marked extra 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 likely related to chronic pancreatitis. The main pancreatic duct appears to merge with a smaller duct in the uncinate process and extends anteriorly where it may enter the more proximal duodenum at the minor papilla (possible pancreas divisum) and communicates with the complex fistulous tract, compatible with the patient's known pancreatic-cutaneous fistula. No discrete fluid collection.3.Large pleural effusions.