16 year old female patient status post gastric sleeve procedure in Jordan, now with draining fistula and concern for pancreatic injury. Evaluate for pancreatic injury. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. No intra- or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is non-dilated within the body and tail. The duct is poorly visualized, but non-dilated within the pancreatic head.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are multiple prominent mesenteric lymph nodes.BOWEL, MESENTERY: Post-surgical changes of a gastric sleeve procedure with a multiloculated fluid collection within the upper abdomen adjacent to the proximal transverse colon, the gastric remnant, and the proximal duodenum. There appears to be at least one cutaneous fistula within the right abdominal wall (image 34, series 7). There is wall thickening and likely secondary inflammatory changes of the proximal transverse colon.BONES, SOFT TISSUES: There is a 3.6 x 5.4 cm fluid collection within the right anterior abdominal wall (image 40, series 7), which communicates with the likely enterocutaneous fistula as described above. There are surrounding inflammatory changes within the right ventral abdominal wall. OTHER: There are significant inflammatory changes within the upper abdomen.
1.Post-surgical changes to the stomach and a multiloculated fluid collection within the upper abdomen adjacent to the gastric remnant/proximal duodenum with fistulous connection to the right ventral abdominal wall, likely representing a complex enterocutaneous fistula. 2.Non-dilated pancreatic duct without specific evidence of pancreatic ductal injury. 