History of perianal pain. Evaluate for pouchitis or perianal disease. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post proctocolectomy with an ileal pouch anal anastomosis (J-pouch). The J-pouch is nearly completely collapsed making evaluation suboptimal. There is a 3.4 x 1.4 cm intrinsically T1 and T2 hyperintense collection in the pelvis which is inseparable from the right lateral aspect of the collapsed J-pouch which demonstrates subtle peripheral enhancement. Although this may represent fluid in the lumen of the collapsed pouch, a definite bowel wall along the right lateral aspect of this collection is not delineated and an intramural or peri-enteric fluid collection cannot be excluded. Alternatively, this may represent mild pouchitis.Non-specific subcentimeter focal outpouching of the left lateral aspect of the collapsed pouch is only seen on a series 4 image 32 and may represent a small ulceration or redundant collapsed bowel wall. There may be submucosal fat deposition in portions of the pouch wall, suggestive of prior inflammation. BONES, SOFT TISSUES: There is a very subtle enhancing tract extending from the anterior aspect of the anal canal (approximate 12:00 position) extending anteriorly and towards the left for approximately 2 cm, best appreciated on the restricted diffusion images (series 7 image 30 through 33) and postcontrast images series 9 image 155 through 146). This terminates tract terminate caudal to the aforementioned collection without a direct communication. The tract does not extend tot he perineal skin surface. OTHER: No significant abnormality noted.
1. Blind-ending sinus tract extending from approximately 12:00 o'clock position of the anal canal.2. Suboptimal evaluation of the J-pouch due to collapse. 3.4 x 1.4 cm intrinsically T1 and T2 hyperintense collection in the pelvis which is inseparable from the right lateral aspect of the collapsed J-pouch which demonstrates subtle peripheral enhancement. Although this may represent fluid in the lumen of the collapsed pouch, a definite bowel wall along the right lateral aspect of this collection is not delineated and an intramural or peri-enteric fluid collection cannot be excluded. Alternatively, this may represent mild pouchitis and adjacent inflammation. Relatively collapsed appearance of J-pouch may be secondary in part to chronic inflammation. Correlation with pouchoscopy findings is recommended. Additional imaging may include a fluoroscopic pouchogram and/or CT study to help delineate the anatomy as clinically indicated. 