Seen in the ED: Diarrhea and BUQ Pain

The woman is in her mid-fifties, diarrhea has been persistent for 10 days and BUQ pain for 2 days. What does the CT show? What's your diagnosis?

History of present illness

A woman in her mid-fifties presents to the emergency department complaining of 10 days of diarrhea and 2 days of constant bilateral upper quadrant abdominal pain. Her medical history is significant for hypertension, diabetes mellitus, end stage renal disease, and polycystic kidney disease (PCKD). She is being treated with insulin, lisinopril, and Prevacid. She denies any fever, bleeding, vomiting or other complaints.

Vital signs & physical examination

Vital signs are normal except for a pulse of 112. BP is 92/47. Physical exam is normal except for bilateral upper quadrant tenderness with mild voluntary guarding.

Relevant test results

Labs: WBC 17, Na 130, BUN 40, Cr 1.8, otherwise normal

Imaging: CT findings below

CT abdomen, sagittal and transverse views
CT abdomen, sagittal and transverse views

What is the most likely diagnosis?

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