Female 38 years old Reason: secretin stimulation needed - recurrent acute pancreatitis; history of lap chole in 2001 - but still stones in remnant cystic duct vs. partial gallbladder?? History: secretin stimulation needed - recurrent acute pancreatitis, history of lap chole in 2001 - but still stones in remnant cystic duct vs. partial gallbladder?? ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are subcentimeter hypervascular lesions that are too small to characterize. There is severe narrowing and thrombosis of the portal vein about the porta splenic confluence. The intrahepatic portion of the portal vein is patent.There are postsurgical clips in the gallbladder fossa. There is a fluid containing structure within the gallbladder fossa measuring 4.1 x 3.2 cm that contains multiple small stones. This is in connection with the bile duct and may represent either a gallbladder remnant or dilatation of the cystic duct remnant. The wall is thin measuring under 2 mm. There is no surrounding inflammation.Intrahepatic bile ducts and common bile duct are normal in caliber. No luminal filling defects to suggest stones.SPLEEN: Spleen is enlarged. There are multiple perigastric venous collaterals from splenic venous thrombosis.PANCREAS: There is residual inflammation about the tail of the pancreas that extends into the splenic hilum and to lesser degree around the head and proximal body of the pancreas. The pancreatic duct is mildly dilated within the tail with a possible tiny pseudocyst in the tail. There is subtle narrowing in the midportion of the pancreatic duct.Slightly blunted response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a right renal cyst. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Multiple small stones within either a residual bladder or dilated cystic duct remnant without choledocholithiasis or biliary ductal dilatation.2.Residual inflammation in the pancreas with mild tail pancreatic ductal dilatation and narrowing in the mid pancreatic duct which may represent a developing stricture or due to residual inflammation.3.Thrombosed splenic vein and portal vein near the portal splenic confluence with venous collaterals.