45 years, Female, Reason: hx of Crohn's disease , on ct with new ileal inflammation History: hx of Crohn's disease , on ct with new ileal inflammation. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a left lower quadrant colostomy. At the 12 o'clock position, 2.1 cm superior to the ostomy, there is a colocutaneous fistula which communicates with the colon at the abdominal wall. The colon proximal to the ostomy to the splenic flexure has wall thickening, enhancement and diffusion restriction compatible with active inflammation. There is mild distention of colon proximal to this segment measuring up to 4.6 cm in diameter. There is a separate segment of inflammatory changes in the neoterminal ileum, immediately proximal to the ileocecectomy, extending approximately 13 cm with wall thickening, enhancement and diffusion restriction compatible with active disease.No abscesses identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A suprasphincteric fistulous track is again visualized arising from the rectum at the 3 o'clock position and traversing the intra-sphincteric space and levator ani, entering the left ileoanal fossa and forming multiple branches, one of which terminates posteroinferiorly in the left gluteal cleft. This is similar in distribution to the prior exam although, less inflammation and edema is noted. There is a sinus tract which travels posteriorly from the rectum at the same level which is unchanged. Multiple abscesses seen previously have resolved. Evaluation of fistulous seen on the prior exam more inferiorly within the perineum are not within the field of viewBONES, SOFT TISSUES: Hemangioma within a lower vertebral body.OTHER: Small fluid in the pelvis.
1.Two segments of active Crohn's disease involving the neoterminal ileum and distal colon immediately proximal to the ostomy2.Colocutaneous fistula adjacent to the ostomy.3.Complex perianal fistulas appear slightly improved from the prior exam but are incompletely visualized and suboptimally evaluated on this study..