History of nausea, vomiting, abdominal pain and concern for obstruction. Crohn's disease involving the terminal ileum, cecum and ascending colon seen on colonoscopy dated 9/25/2015. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement without a focal lesion. It measures 20 cm in craniocaudal dimension. No intrahepatic or extrahepatic biliary ductal dilatation.Large gallstone within a normally distended gallbladder without evidence of acute inflammation.SPLEEN: The spleen is normal in size signal intensity and without a focal lesion.PANCREAS: The pancreas is normal in morphology, signal intensity and enhancement without a focal lesion or main pancreatic ductal dilatation. Normal variant ductal anatomy. Splenule near pancreatic tail. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach and small bowel is adequately distended with oral contrast.The small bowel fold pattern is maintained.The terminal ileum is well seen and demonstrates a long segment of T2 weighted wall hyperintensity, thickening, restricted diffusion and enhancement with moderate luminal narrowing extending for approximately 6 cm. This is followed by a 2 cm skip segment followed by a long segment of active inflammation involving approximately 7 cm of the ileum with moderate luminal narrowing resulting in severe poststenotic/upstream dilatation up to 4.1 cm involving approximately 22 cm of small bowel. Proximal to this dilated segment is another 6 cm segment of active inflammation with moderate luminal narrowing and mild proximal dilatation. Several additional skip lesions and skip segments extends proximally and involve much of the mid and proximal ileum with associated moderate pre-stenotic dilatation of the jejunum.Note is made of irregular conical contour of the cecum, compatible with chronic inflammation. The colon otherwise demonstrates no specific evidence of active inflammation or a flow-limiting stricture.There is a small amount of interloop fluid and peri-enteric inflammatory changes including fibrofatty proliferation and engorged mesenteric vasculature. No loculated fluid collection to suggest an abscess.No definite fistula is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pleural effusions. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Extensive active inflammation involving long segments of the ileum with intervening skip segments superimposed on persistent moderate luminal narrowing with associated pre-stenotic/upstream dilatation suggestive of underlying fibrostenotic strictures.2. Interloop fluid without a loculated fluid collection to suggest an abscess or definite sinus tract/fistula formation.3. Chronic inflammatory changes of the cecum. No definite active inflammation of the colon otherwise.4. Trace effusions. Gallstone. 