Male; 50 years old. Reason: 48M with h/o chronic pancreatitis and recurrent acute pancreatitis, s/p surgical cystogastrostomy by Dr. Roggin in 2010, followed by a pseudocyst. Now with concern for percutaneous fistula along midline incision History: Concern for fistula Lack of intravenous contrast limits sensitivity for solid organ pathology.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Mild pancreatic atrophy with prominence of the main pancreatic duct and a few side branches seen, as well as slightly patchy T1 signal, suggestive of chronic pancreatitis. No focal pancreatic lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: In the area of previously described soft tissue induration at the anterior midline on the recent CT, there is an 8 x 12 mm subcutaneous fluid collection (series 9/20) which likely communicates with a 12 x 33 mm fluid collection just beneath the anterior peritoneal surface (series 7/23). This latter fluid collection has a linear low T2 signal tract extending to the mid transverse colon (series 7/22). Overall, the findings are most suspicious for small enterocutaneous fistula with associated fluid collections involving the transverse colon and anterior abdominal wall.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Findings suspicious for small enterocutaneous fistula extending from the transverse colon to the anterior abdominal wall, though evaluation is limited without intravenous contrast. Findings could be confirmed with retrograde fistulography.