Presacral fluid collection. History of ulcerative colitis status post total abdominal colectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Probable gallbladder sludge within an otherwise unremarkable gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate cysts and too small to characterize presumed renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post total abdominal colectomy. Right lower quadrant end jejunostomy. The proximal small bowel is collapsed without gross abnormality. The stomach, duodenum and distal small bowel is well distended without wall thickening, abnormal enhancement or adjacent inflammatory changes.BONES, SOFT TISSUES: Mild anterior abdominal wall laxity without evidence of complication.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: In the presacral space there is a fluid-filled peripherally enhancing collection measuring 2.4 x 1.5 cm (series 21/37) which has been previously noted on CT to contain high attenuation debris. Along the left inferolateral aspect the collection appears to be intimately related to the ileoanal pouch (per EPIC patient has history of J-pouch with typical appearance on CT) (series 6, image 26). A collapsed portion of the blind end of the J-pouch is a consideration, however a presacral fluid collection is still favored. Along the right inferolateral aspect of the collection there is a fistulous tract extending inferiorly communicating with a tract (series 21 image 39 through 44) at the 7 o'clock position of the anus and exiting at approximately the 1:00 position of the anus and inferoanteriorly to the left labia (series 21 image 47 through 55).There are no significant adjacent soft tissue inflammatory changes. The ileoanal pouch abuts abut the posterior lower uterus and posterior vaginal wall and there are adjacent dependent small bowel loops in the pelvis. The pouch is tethered to the left lateral posterior pelvic wall. The small bowel loops appear to be opacified with high intensity oral contrast which does not appear to communicate into the ileoanal pouch. Communication with the vagina cannot be entirely excluded.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
The presacral collection has slightly increased in size. It intimately abuts the superior aspect of the ileoanal pouch which raises the possibility that this is the free end of the pouch, however a loculated fluid collection is favored. There is a fistula extending from the collection into the anal canal and the left labia as described above.There is no clear fistulous communication between the ileoanal pouch and the dependent small bowel loops in the pelvis or the adjacent uterus and vaginal canal. A limited barium enema may be considered to evaluate the ileoanal pouch and assess the possibility of communication with the aforementioned presacral fluid collection.