35-year-old female with Crohn's disease with fistulization. Status post multiple resections. Presents with abdominal pain, diarrhea, and fever. There is a question of a ruptured left ovarian cyst. ABDOMEN:LIVER, BILIARY TRACT: Again seen is a large right hepatic lobe hemangioma, appearing similar to the prior study. An additional subcentimeter focus of fluid signal intensity is identified in the left lobe of the liver, which is too small to characterize, but likely represents a simple cyst, unchanged. There is no intra-or extrahepatic biliary ductal dilatation. The hepatic vasculature is patent.SPLEEN: Subcentimeter focus of fluid signal intensity in the spleen is too small to characterize, but may represent a simple cyst.PANCREAS: Again seen are findings consistent with pancreatic divisum. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a long segment area of wall thickening, hyper enhancement and hypomotility measuring approximately 13 cm in length. The previously described wall thickening and stenosis appears less pronounced when compared to the prior study. The previously described marked enhancement of the distal ileum also appears decreased when compared to the prior study. The ileo-cecal anastomosis is again noted to be patent without significant inflammation or stenosis.Again seen is hyperenhancement of the distal sigmoid colon with wall thickening compatible with active fibro-stenotic disease, also appearing improved when compared to the prior study.Again seen is a transsphincteric perianal fistula formation at the 7 to 8 o'clock position of the rectum. This fistula is again noted to communicate with an intersphincteric perianal fistula located at the 6 o'clock position. The intersphincteric fistula is associated with a small subcentimeter perirectal fluid collection which appears decreased in size when compared to the prior study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral retropectoral breast implants are incompletely visualized.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a long segment area of wall thickening, hyper enhancement and hypomotility measuring approximately 13 cm in length. The previously described wall thickening and stenosis appears less pronounced when compared to the prior study. The previously described marked enhancement of the distal ileum also appears decreased when compared to the prior study. The ileo-cecal anastomosis is again noted to be patent without significant inflammation or stenosis.Again seen is hyperenhancement of the distal sigmoid colon with wall thickening also appearing improved when compared to the prior study.Again seen is a transsphincteric perianal fistula formation at the 7 to 8 o'clock position of the rectum. This fistula is again noted to communicate with an intersphincteric perianal fistula located at the 6 o'clock position. The intersphincteric fistula is associated with a small subcentimeter perirectal fluid collection which appears decreased in size when compared to the prior study.BONES, SOFT TISSUES: Note is made of multiple foci of metallic susceptibility artifact in the soft tissues overlying the anterior aspect of the right hemipelvis.OTHER: Note is made of nonspecific free fluid within the pelvis which is nonhemorrhagic. No definitive ovarian cysts are identified on the prior examination and clinical correlation is indicated. Multiple follicles in the left ovary.
1.Interval improvement of the previously described findings, as detailed above. 2.Persistent perianal fistula formation.3.Nonspecific free fluid in the pelvis. 