Female 35 years old Reason: cause for abdominal pain: acute on chronic pancreatitis Vs active Crohn's disease? History: abdominal pain, increased CRP. The patient was unable to tolerate the full dose of enteric contrast. Patient also had difficulty following breathing instructions which somewhat limits image quality. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: Findings suggestive of chronic pancreatitis with unilocular cysts identified in the pancreatic head, stable in appearance compared to prior study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is marked gastric dilatation which may in part relate to contrast ingestion as per CT enterography protocol or may relate to chronic narcotic use. There is above average stool burden and marked dilatation of the entire colon which again may relate to chronic narcotic use. There is abnormal dilatation of the small bowel measuring up to 3.8 cm. Long segment of mural thickening and luminal involving the distal ileum with intervening skip lesions. There is asymmetric abnormality of the mesenteric wall and pseudo-sacculations. The appearance is suggestive of acute or chronic inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Intrauterine device within the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Long segment of distal ileum abnormality suggestive of acute on chronic inflammation with intervening skip lesions. The proximal small bowel is dilated suggesting a partial bowel obstruction.2. Gastric and colonic distention which is likely related to chronic narcotic use. 3. Chronic pancreatitis.