43-year-old female. Crohn's disease, status post complete colectomy with ileostomy. Report from outside hospital shows a 3 x 3 cm mass containing gas adjacent to ileostomy compatible with probable abscess. Evaluate for abscess versus bowel wall thickening due to Crohn's flare. CHEST: LUNGS AND PLEURA: Minimal bibasilar atelectasis. No pulmonary nodules. No pleural effusions or focal airspace consolidation. MEDIASTINUM AND HILA: No mediastinal or hilar adenopathy. The heart size is normal. No left ventricular hypertrophy. No pericardial effusion. CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormalities seen within the liver or gallbladder. SPLEEN: No significant abnormality noted. KIDNEYS, URETERS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted. PANCREAS: No significant abnormality noted. RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes. Small mesenteric nodes identified as well. BOWEL, MESENTERY: There is a 3.9 x 4 cm rim enhancing loculated fluid collection with internal gas at axial image 98/157 extending from the rectal sheath into the subcutaneous fat at the site of the ileostomy. This is compatible with a uniloculated abscess.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted. PELVIS: UTERUS, ADNEXAE: Patient is status post hysterectomy. There is a 4.8 x 3 cm mass in the right adnexa (image 120/157 series number 3). This is this was present on the prior examination it appears slightly smaller. If indicated the mass may be further evaluated with transvaginal ultrasound or MRI. The left adnexa is unremarkable. BLADDER:Unremarkable LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: Right lower quadrant ileostomy is present compatible with patient's known Crohn's disease and total colectomy. Cyst present in the subcutaneous tissues just lateral to the ostomy site. See both. In addition, multiple loops of small bowel have wall thickening in the pelvis which is new since the prior CT examination of 1/6/08. The wall thickening is best seen at axial image 121/157 of series 3 and is compatible with a Crohn's flare. No intraperitoneal abscess and no bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No other significant abnormality was found.
1. Status post colectomy with right lower quadrant ileostomy. New abscess lateral to ostomy site. Crohn's flare involving pelvic small bowel loops. See above.2. Large right adnexal mass which is not completely evaluated on this examination. The mass appears slightly smaller since 1/6/07. If indicated, transvaginal ultrasound or MRI would be helpful in further evaluating this lesion. 