46 years, Female, Reason: History of small bowel, colonic, and perianal fistulizing Crohn's disease. Needs assessment of disease activity and rectovaginal fistula. History: abdominal pain, diarrhea, rectovaginal fistula drainage. Please include cuts of the the perineum.. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney is atrophic with severe hydronephrosis, likely chronic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:There is an area of narrowing with bowel wall thickening, diffusion restriction and hyperenhancement in the distal ileum, proximal to the terminal ileum, which extends 5 to 10 cm in length and causes proximal small bowel obstruction with loops dilated to 3.9 cm. This segment remains narrowed on multiple sequences, likely representing stricture. There are two fistulous tracts which extend from this strictured segment to the adjacent sigmoid colon (6/16 and 6/21). The sigmoid appears narrow on T2 weighted images but expands on subsequent imaging sequences.No evidence of abscess. No evidence of perirectal fistulas. No evidence of rectovaginal fistula as clinically questioned.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: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Inflammatory changes in the distal ileum with stricturing and two ileosigmoid fistulas.2.Small bowel obstruction proximal to the narrowed ileal segment.3.No evidence of rectovaginal fistula on MRI. If there is strong clinical concern, a barium fluoroscopic study may be considered4.Atrophic left kidney with severe hydronephrosis, likely chronic.