60 year-old male with pain and constipation. Rule-out obstruction. The the patient has cholangiocarcinoma, status post Roux-en-Y resection and cholecystectomy. ABDOMEN:LIVER, BILIARY TRACT: The circumferential mass encasing the common hepatic duct at the confluence of the main, right and left ducts is smaller with resolution of the intrahepatic biliary ductal dilatation since the MRI examination in September 2010. No new or additional hepatic lesions were identified.SPLEEN: Not seen. Presumed splenectomy. PANCREAS: No pancreatic ductal dilatation is identified. No significant abnormality is seenADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged periportal and portacaval lymph nodes are identified. The largest of which is portocaval measuring 2 x 1.5 cm. (image number 39; series number 3.). ABOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Status post mesh reconstruction of the abdominal wall with large numbers of surgical staples.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The rectosigmoid is markedly dilated with inspissated stool compatible with constipation. There is a 3-cm long segment of sigmoid which appears markedly narrowed with increased wall thickness and coronal image 65 and axial image 90 - 92 of series 3. This could represent spasm or a colonic lesion not seen on the 9/29/2010 MR examination.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
1.Hepatic findings are consistent with cholangiocarcinoma, status post Roux-en-Y resection. Severe constipation. Questionable lesion in sigmoid colon.2.Periportal and portacaval lymphadenopathy. 