27 year old female complaining of abdominal pain with history of Crohn's disease status post two bowel resections and planned placement of Seton tube for drainage treatment of multiply recurring high-spreading extrasphincteric perianal fistula. Evaluate for perianal abscess. ABDOMEN:LUNG BASES: No pleural effusions. LIVER, BILIARY TRACT: Periportal low attenuation compatible with periportal edema was seen on the prior exam, but this has resolved. No focal liver lesions. SPLEEN: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense lesions are too small to characterize.ADRENAL GLANDS: There is a 0.8 x 1.7 cm cystic lesion associated with the left postero-lateral adrenal limb on axial image 19/145. This was present on the prior examination and appears unchanged. If indicated, further evaluation with dedicated adrenal CT or preferably, MRI examination would be helpful to characterize this lesion.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall thickening of the terminal ileum and cecum identified. This is near the anastomosis. No surrounding fluid collections.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:UTERUS, ADNEXA: An IUD is in place. Minimal free fluid identified within the pelvis.There is a relatively hypodense object in the right vagina / adnexa on coronal image 53/109 measuring 1.7 x 5 cm which may be a tampon or other foreign object. This appears unchanged in position and size since the prior exam. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Minimal wall thickening of the descending colon seen on the prior exam has resolved without evidence of abscess formation. No free air or pneumatosis.In the interval since the prior examination, multiple air collections which extend posteriorly towards the sacrum and extend to the left lateral aspect of the rectum have developed. These are seen best on axial image 128/145 and coronal image 41/109. No abscess was found.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
New air collections in in presacral and left lateral aspect of the rectum have developed since the prior examination. No abscess was found. Exam is stable otherwise. Probable tampon in vagina - see above. 