52-year-old male with Crohn's disease status post perianal proctectomy and resection of coccyx, urethroplasty complicated by a urethral cutaneous fistula, evaluate for osteomyelitis. Please note that this exam was protocoled for evaluation of the osseous structures and not the soft tissues of the pelvis. The coccyx has been removed. There has been interval resolution of a fluid collection adjacent to the sacrum. There is residual enhancement surrounding the distal sacrum and mild increased T2 signal in the marrow, which may be reactive in etiology.A Foley catheter extends to the bladder. Postoperative changes of the pelvis compatible with stated history of proctectomy. If there is concern for fistula, MR enterography is recommended.
Postoperative changes of coccygeal resection with interval resolution of fluid collection at the base of the sacrum. There is mild residual enhancement and increased T2 signal which is likely reactive or postoperative in etiology without specific evidence of osteomyelitis.