Evaluate for obstructive mass. Patient found to have duodenal obstruction at D2/D3 on upper GI study 1/21/2016. Metastatic urothelial bladder cancer with retroperitoneal lymph nodes. ABDOMEN:LIVER, BILIARY TRACT: Numerous bilobar subcentimeter T2 hyperintense lesion, too small to characterize, similar to prior.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral percutaneous nephroureterostomy stents are in place, terminating in the urinary bladder, unchanged from prior. No hydronephrosis. Left lower pole simple cyst, unchanged.RETROPERITONEUM, LYMPH NODES: Paraduodenal lymph node measures 1.0 x 0.8 cm (Series 1104, image 80). Additional small retroperitoneal lymph nodes are present.BOWEL, MESENTERY: Enteric tube terminates within the stomach. There is severe narrowing/obstruction of the second/third portion of the duodenum (series 4, image 31), compatible with prior site of obstruction on upper GI series January 21, 2016, and probably progressed from prior CT January 20, 2016. These findings may represent a high-grade stricture, anterior paraduodenal hernia or less likely mass. Status post left lower quadrant colostomy. There is unchanged colonic wall and perirectal thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Severe narrowing/obstruction of the second/third portion of the duodenum, may represent a high-grade stricture, paraduodenal hernia or less likely mass. Upper endoscopy is recommended. 2.Unchanged colonic and bladder wall thickening.Findings were discussed by Dr. Stephen Thomas with the surgical team January 25, 2016.