History of Crohn's disease and nausea vomiting and diarrhea. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. The liver is normal in morphology, size and signal intensity. No suspicious lesion or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained. The terminal ileum is well seen.The small bowel is normal in caliber and wall thickness without abnormal signal intensity, restricted diffusion, postcontrast enhancement or adjacent inflammatory changes such as mesenteric vessel engorgement or fibrofatty perforation.No fixed luminal narrowing or associated prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No free fluid or loculated fluid collection.The colon is normal in caliber and wall thickness without adjacent inflammatory changes, improved from prior.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained. The terminal ileum is well seen.The small bowel is normal in caliber and wall thickness without abnormal signal intensity, restricted diffusion, postcontrast enhancement or adjacent inflammatory changes such as mesenteric vessel engorgement or fibrofatty perforation.No fixed luminal narrowing or associated prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No free fluid or loculated fluid collection.The colon is normal in caliber and wall thickness without adjacent inflammatory changes, improved from prior.BONES, SOFT TISSUES: Demonstrated again is a transsphincteric fistula extending from the 4 o'clock position into the left ischioanal fossa associated with a small subcentimeter collection. It splits anterolaterally towards the left obturator muscle and posteromedially to the skin in the midline, unchanged from the prior. There is minimal thickening of the rectum compatible with mild active disease.OTHER: No significant abnormality noted.
1.Previously improved descending/sigmoid colon wall thickening and enhancement has improved. No specific evidence of active bowel inflammation, fibrostenotic or sinus/fistulous disease. 2.No significant change in the left ischioanal fistula with a small abscess as described above.