Reason: evaluate for crohn's disease activity and distribution, identify strictures / inflammation History: abdominal pain, bloating ABDOMEN:LIVER, BILIARY TRACT: Visualized portions demonstrate no significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post small bowel resection and ileocecectomy with neoterminal ileum. The neoterminal ileum is felt to be best seen on series 3 image 24 in the right upper quadrant. Given the thicker sections of MRI, it is very difficult to localize which portion of the small bowel with disease is involved, however it is not the duodenum or proximal jejunum. The loops involved are likely distal jejunum and ileum. Given this, there is long segment narrowing with interspersed bowel dilatation throughout the abdomen and pelvis, along with fibrofatty proliferation and increased vascularity. UPPER ABDOMEN:An approximately 8 cm segment of fixed narrowing (3:17) may correlate with prior inflammation and narrowing seen on CT from 2014 (10:50). The small bowel proximal to this measures up to 5.7 cm in diameter (11:35). Another segment of narrowing is seen anteriorly (3:22) which is approximately 12 cm (also seen on series 11:36). Both of these segments appear to have an active component of inflammation (14:68) and (14:48) and are actually very close to each other. Another 2.5 cm segment of active inflammation narrowing is seen (14:43) that is slightly more distal or proximal to the lesions described above. Numerous prominent mesenteric lymph nodes are also noted.LOWER ABDOMEN AND PELVIS: Numerous dilated small bowel loops are seen with areas of interspersed narrowing similar to the upper abdomen. The postcontrast images are difficult to assess for active disease. However, the T2 signal and appearance of the bowel appears narrowed with dilated small bowel on either side. For example, a segment measuring approximately 2.8 cm (4:15).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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Acute on chronic/fibrostenosing Crohn's disease as described above with several strictured small bowel segments with intervening bowel dilatation.