History of Crohn's disease of the sigmoid colon with stricture. History of hysterectomy and cholecystectomy. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. There is a non-specific 2.4 x 2.1 cm fluid collection in the cholecystectomy bed. The liver is normal in morphology, size, signal intensity and enhancement without a focal lesion. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. The pancreas parenchyma is normal in morphology and signal intensity. No stigmata of acute or chronic inflammation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric perirenal fluid. Simple appearing cysts. No suspicious lesion or hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The proximal small bowel and uninvolved colon is normal in caliber, wall thickness, signal intensity and without adjacent inflammatory changes. See discussion below.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Complex fistulous phlegmon within the mid pelvis involving the sigmoid colon (series 5/28). There is fistulous communication between the mid sigmoid colon and distal rectosigmoid colon. There is fistulous communication with the vaginal cuff with increasing material in the vaginal canal during the examination. Additionally there is mild tethering of the adjacent small bowel loops anterior to the rectosigmoid colon without definite fistulous communication. Additionally there is a blind-ending sinus tract extending superiorly into the mesentery. The appendix appears tethered to the fistulous phlegmon.The involved colon demonstrates significant active inflammation. There is stasis of stool proximal to the involved sigmoid colon without significant dilatation.No drainable fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Complex clover-leaf fistulous phlegmon with colocolonic and colovaginal fistulous communication and active inflammation of the involved rectosigmoid colon. Tethering of adjacent small bowel loops and the appendix. Blind-ending sinus tract extending superiorly into the mesentery. No drainable fluid collection.2. No additional sites of active bowel inflammation or flow-limiting stricture.3. Pancreas divisum. Nonspecific 2.4 cm fluid collection in the cholecystectomy bed. Assuming the patient is asymptomatic this likely represents a benign postoperative fluid collection.