49-year-old female with concern for bile leak from edge of liver, bilious drain output. Additional clinical history reveals colon cancer with liver metastasis status post right liver resection earlier this year postop day two from a right hemicolectomy which was adhesed to the liver margin and duodenum. ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy and cholecystectomy, small amount of fluid at postoperative site stable to mildly decreased. The common bile duct measures up to 8 mm and appears similar to that seen on the prior CT. No focal discontinuity of the biliary system.Small T2 hyperintense focus in the right hepatic lobe most likely a cyst.SPLEEN: Splenorenal varices are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole cyst. No hydronephrosis bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a large right upper quadrant air-fluid collection with a drain terminating within the largest portion of this collection. Small amount of proteinaceous material/blood is noted in the dependent portion of the collection. There is mild wall enhancement of the dependent peritoneal surfaces. Free fluid surrounds the greater curvature of the stomach.The pylorus and D1/D2 segments of the duodenum appears edematous with discontinuous mucosal enhancement that is intimately associated with the large air-fluid collection. Adjacent loops of small bowel also appear edematous. No evidence of small bowel obstruction.BONES, SOFT TISSUES: Body wall edema is present. Amorphous dark signal is noted along the left anterior abdominal wall which may reflect subcutaneous emphysema. Susceptibility artifact from surgical material in the midline anterior abdominal wall.OTHER: Trace bilateral pleural effusions with adjacent atelectasis/consolidation.
1.Large right upper quadrant air-fluid collection with a drain placed as described above. Intimately associated pylorus and D1/D2 segments of the duodenum appears edematous with discontinuous mucosal enhancement. No biliary duct discontinuity is evident. Provided the large amount of air and intimate association of collection with the duodenum and possible duodenal mucosal discontinuity, findings favor the duodenum as a source of biliary leak. Superimposed infection cannot be entirely excluded. 2.Status post right hepatectomy with postsurgical changes as described above. 