History of Whipple procedure for ampullary benign papillary neoplasm. Specifically pancreatic-type IPMN. ABDOMEN:LIVER, BILIARY TRACT: There are post surgical changes of a Whipple procedure including a hepaticojejunostomy. There is intrahepatic and extrahepatic biliary ductal dilatation to the level of the anastomosis which is unchanged from the prior study. Otherwise the liver is normal in morphology size and signal intensity. No focal suspicious lesion.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes of a Whipple procedure including a pancreaticoenterostomy . There is stable dilatation of the pancreatic duct to the level of the anastomosis compatible with focal stricturing. As seen on the recent prior study there is an additional focal stricture of the pancreatic duct at the level of the pancreatic body. Following secretin administration there is no significant increase in fluid secretion or change in pancreatic ductal caliber. The stricture persists during administration of secretin.No evidence of pancreatitis.The previously seen fluid collection along the inferior margin of the liver anterior to the pancreaticoenterostomy contains a gastrocystostomy drainage catheter without a measurable fluid collection at this time.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are mild inflammatory changes of the anterior abdominal wall without an associated fluid collection. A small bowel loop is noted immediately deep to the anterior abdominal wall incision site without evidence of bowel dilatation.OTHER: No significant abnormality noted.
1.Interval near complete resolution of the subhepatic fluid collection with gastrocystostomy catheter in place.2.Stable dilatation of the pancreatic duct likely reflecting an anastomotic stricture. Stable stricture at the level of the body of the pancreas. No normal response to secretin administration.3.Mild anterior abdominal wall inflammation without abscess. 