Recent recurrent small bowel obstruction. Evaluate for extent of Crohn's disease. 6/13/2014 biopsy showed mildly active chronic enteritis of the ileum. 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast.There are long segments of fixed narrowing, indicating strictures, involving the small bowel in the right hemiabdomen including the terminal ileum and distal small bowel with associated fibrofatty perforation, mild circumferential wall thickening, restricted diffusion and postcontrast enhancement. These are not completely contiguous compatible with at least 3 skip lesions. There is moderate prestenotic/upstream small bowel dilatation, however these are not flow limiting strictures as there is oral contrast in the right colon. The lesion of the terminal ileum involves approximately 9 cm. More proximally there is a lesion measuring approximately 15 cm.There is mild angulation of the small bowel in the right lower quadrant towards the mesentery suggesting non-obstructive adhesive inflammatory changes.Also note is made of a pedunculated polypoid lesion in the distal small bowel measuring 1 cm (series 15/28), compatible with an inflammatory polyp.No free fluid or loculated fluid collection. No specific findings of sinus tract or fistula formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Multifocal skips lesions of acute inflammatory changes of the distal small bowel superimposed on moderate length nonflow-limiting chronic strictures. There is upstream/prestenotic dilatation of the small bowel, consistent with partial obstruction (fluid seen distally in colon). The total length of disease involvement is at least 24 cm.At least one presumed inflammatory polyp in the distal small bowel, measuring up to 1 cm.