36-year-old male with history of Crohn's disease presents with fevers, chills, pain; evaluate for abscess. Status post recent fistula repair (on 2/5/2010) with abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable hypodense lesions within the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Marked thickening of the terminal ileum and multiple loops of bowel appearing have resolved since the prior exam. The ileosigmoid fistula seen on the prior exam has been resected. There are post-op changes in the right lower quadrant from recent endocsopic procedure. Small amount of intraperitoneal fluid and subcutaneous / intraperitoneal gas are attributed to post-op changes. Contrast is present in the terminal ileum, but not the sigmoid, suggesting that the fistula has been repaired. BONES, SOFT TISSUES: No significant abnormality notedOTHER: New fluid collections with gas bubbles in the rectus muscles near the midline bilaterally, seen best on axial image 93/163 of series 12 and coronal image 67 have enhancing rims, compatible with abscess. These are new since the prior exam. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Prominent bladder.LYMPH NODES: Borderline enlarged inguinal nodes. No other significant abnormality.BOWEL, MESENTERY: Rectal intramural fistula tract extending to the scrotum is reidentified and is subtle; however, this is incompletely evaluated by CT and may be better seen with MRI, if indicated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
1. Ileitis with narrowing of the terminal ileum and fistula between the ileum and the sigmoid colon have resolved since the prior exam. 2. A rectal intramural fistula to the scrotum is less prominent on this exam; however, it is incompletely evaluated on CT and MRI is recommended, if indicated.3. New abscess in the rectal sheath bilaterally.