History of Crohn's disease. Evaluate perianal disease. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: The urinary bladder is decompressed with a Foley catheter balloon. Note is made of mucosal enhancement which may be iatrogenic.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are numerous communicating peripherally enhancing fluid collections nearly entirely encasing the distal rectum predominantly within the ischiorectal fossa, compatible with multiple abscesses. One of the locules extends through the right lateral levator ani musculature measuring 2.5 x 1.9 cm. The largest component stems to the presacral space measuring 2.6 x 2.0 cm (series 7/33).One of the locules extends anteriorly towards along the right aspect of the levator ani musculature (series 7/46).There is a drainage device terminating in an abscess adjacent to the right anterolateral distal rectum in the intersphincteric space appears to traverse the 6 o'clock position of the rectum. The collection appears to have a small communicating channel with the other perirectal fluid collections described above.There is a suspected distal rectal intramural abscess measuring 6 mm (series 7/41).There are multiple mucosal abnormalities/sinus tracts of the rectum including the 8 o'clock position (series 7,image 68) and 2 o'clock position (series 7, image 62).BONES, SOFT TISSUES: Within the pelvis tracking along the right iliopsoas muscle is a 6.4 x 1.8 cm peripherally enhancing fluid collection (series 1401/47).Small locule of fluid in the gluteal cleft.There is extensive subcutaneous and muscular inflammatory/edematous signal intensity of the pelvic soft tissues without a discrete drainable fluid collection.Large bowel containing ventral hernia is partially imaged. OTHER: No significant abnormality noted.
1. Numerous interconnected peri-rectal abscesses and rectal fistulae/sinus tracts as described above. Small suspected intramural abscess in the left lateral wall of the rectum.2. Right peri-iliopsoas abscess appearing similar to prior CT.3. Extensive soft tissue edema/inflammation of the pelvis.4. Urinary bladder mucosal thickening may be iatrogenic; correlate for cystitis.