20 year old male with a history of IBD. Assess for perianal fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is wall thickening involving the distal sigmoid colon and proximal rectum. Again seen are foci of increased T2 signal abnormality within the bowel wall as well as increased mesenteric vascularity, compatible with active inflammation. Redemonstrated transsphincteric perianal fistulae arising at the 5 o'clock and 7 o'clock positions extending to the skin surface with bilateral setons in place, appearing similar to the prior study. There is interval increase in size of the fluid collection along the right gluteal crease, measuring 11 mm in diameter, consistent with abscess formation (64; series 4). Additionally, note is made of an intersphincteric fistula extending from the 6 o'clock position of the which extends to the skin surface along the left gluteal crease and may communicate with the aforementioned left transsphincteric fistula, which appears more pronounced when compared to the prior examination. BONES, SOFT TISSUES: Heterogeneous lesion within the medial right iliac bone has high T1 and high T2 signal with mild peripheral enhancement consistent with a hemangioma. Heterogeneous bone marrow signal likely represents islands of red marrow.OTHER: Bilateral testicular hydroceles.
1.Persistent bilateral perianal fistula formation, as detailed above. There is slight interval increase in size of a 11-mm fluid collection along the right gluteal crease consistent with abscess formation. Additionally, a right intersphincteric fistula appears more pronounced when compared to the prior study.2.Acute on chronic inflammatory changes involving the sigmoid colon and rectum compatible with known inflammatory bowel disease.