51-year-old female with history of Crohn's ileitis, status post ileocecectomy in 6/2015. Currently not on any medications. Now with right lower quadrant pain. Evaluate for Crohn's disease activity. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right lower pole renal parenchymal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval Ileocecectomy since the 2/9/2015 CT enterography exam. The neoterminal ileum is identified near the hepatic flexure and demonstrates short segment (approximately 5 cm) thickening and T2 hypointensity of the bowel wall. This region also demonstrates persistent narrowing and wall enhancement suggesting active disease.Nondilated small bowel loops within a small right Spigelian hernia also demonstrate questionable wall enhancement and could represent a skip lesion.An adjacent ileal loop near the neoterminal ileum demonstrates a 3.2 cm segment of wall thickening and suspected enhancement, which could also represent an additional skip lesion.No obvious fistulization or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Arising from or abutting the uterus is a 10.2 x 8.9 cm lesion that is hypointense on T2 and demonstrates diffuse avid contrast-enhancement.In the left adnexa, there is a T2 hypointense, T1 hyperintense focus. This could represent a hemorrhagic cyst versus endometrioma.
1.Status post ileocecectomy with findings suggesting active disease within a short segment (approximately 5 cm) of the neoterminal ileum. Additionally, two adjacent ileal segments with suspected wall enhancement are concerning for skip lesions. One of these suspected skip lesions is located within a small spigelian hernia.2.A 10.2 x 8.9 cm T2 hypointense, enhancing lesion abutting the uterus could represent an exophytic fibroid versus an adjacent ovarian Brenner tumor, but favor to be the former.3.A small T1 hyperintense, T2 hypointense lesion in the left adnexa could represent a hemorrhagic cyst versus an endometrioma. Follow-up ultrasound in 3-6 weeks is recommended.