58-year-old man with history of elevated hyperbilirubinemia and bleeding from rectosigmoid varices. ABDOMEN:LIVER, BILIARY TRACT: Simple cyst at the liver dome, otherwise no focal hepatic lesions identified. There is widening of the fissures with hypertrophy of the left lobe suggestive of cirrhosis. TIPS noted and appears patent. Additionally, there are large splenorenal varices and numerous perigastric varices.Patient status post cholecystectomy. There is moderate, diffuse, smooth intrahepatic biliary ductal dilatation and the extrahepatic bile duct is dilated to 11 mm to level of ampulla.SPLEEN: Innumerable subcentimeter splenic cysts identified. The spleen is enlarged.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right superior pole and left mid pole renal cysts noted. Proximal ureters are nondilated.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Partially visualized loops of small bowel are dilated and there is a small amount of free intraabdominal fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Degree of intra and extrahepatic biliary ductal dilatation in this patient status post cholecystectomy could be within normal limits, however an ampullary stenosis cannot be excluded.2.Cirrhotic morphology of liver with patent TIPS and large splenorenal collaterals.3.Small bowel ileus with small amount of ascites.