Reason: Pt w/ mesothelioma s/p multiple debulkings, HIPEC x2, last in September 2015 now w/ chronic SBO - please eval for transition point and eval for recurrent disease History: chronic SBO ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Prominent common bile duct measuring 1.1 cm without an obstructing lesion evident. Mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is mild edema and diffusion restriction involving the pancreatic tail and head which may reflect a mild pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is dilatation of small bowel to 3.8 cm with collapsed terminal ileum and a transition point in the lower pelvis (19/17), likely representing a partial small bowel obstruction. Stool within the colon has slightly increased since the prior exam. There is a rim of low T2 signal surrounding multiple bowel loops in the pelvis, likely reflecting thickening and fibrosis of the peritoneal reflections. No cystic lesions are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Dilated small bowel loops with collapsed terminal ileum likely represents a partial small bowel obstruction; air seen distally in colon.2.There is thickening and likely fibrosis of the peritoneal reflections in the pelvis which is suggestive of sclerosing encapsulated peritonitis, may in combination be contributing to aforementioned partial SBO.3.Bowel thickening involving the rectosigmoid suggests a mild nonspecific proctitis.4.No cystic lesions identified to suggest multicystic peritoneal mesothelioma.