History of Crohn's ileocolitis with fistula. Presents with abdominal pain and bloating. ABDOMEN:LIVER, BILIARY TRACT: Simple appearing right hepatic lobe cysts. No biliary ductal dilatation or vascular abnormality.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: The small bowel is adequately distended with oral contrast. Contrast has reached the distal colon.Long segment narrowing, severe circumferential thickening, hyperenhancement and restricted diffusion of the distal through terminal ileum with surrounding fibrofatty proliferation involving approximately 21 cm of small bowel. The very endmost segment of the terminal ileum is relatively spared but does have submucosal fat indicating chronic/prior inflammation. Proximally there is mild dilatation up to 3.8 cm. There is a short skip lesion approximately 5 cm proximally, similar to prior. Soft tissue tethering/fistulous network involving the distal ileum to the adjacent sigmoid colon and a left lower quadrant more proximal small bowel loop which is mildly thickened.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: Trace amount of free fluid in the pelvis.Long segment narrowing, severe circumferential thickening, hyperenhancement and restricted diffusion of the distal through terminal ileum with surrounding fibrofatty proliferation involving approximately 21 cm of small bowel. The very endmost segment of the terminal ileum is relatively spared but does have submucosal fat indicating chronic/prior inflammation. Proximally there is mild dilatation up to 3.8 cm. There is a short skip lesion approximately 5 cm proximally, similar to prior. Soft tissue tethering/fistulous network involving the distal ileum to the adjacent sigmoid colon and a left lower quadrant more proximal small bowel loop which is mildly thickened.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Severe active inflammation involving approximately 21 cm of the distal through terminal ileum superimposed on a long segment stricture. Short segment skip lesion immediately proximal to this bowel loop. There is mild upstream bowel dilatation, however contrast has reached the distal colon.2.Fistulous network involving the distal ileum, sigmoid colon and more proximal small bowel in the pelvis without definite fluid in the fistulous tracts. The appearance is similar to the prior.