Male 15 years old with Crohn's disease. Evaluate scrotal abscess for tracking or fistula involvement. PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Nondistended and unremarkable.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: An enhancing fistulous tract with surrounding edema extends anteriorly and inferiorly from the right lateral rectal wall along the right aspect of the perineum to the base of the scrotum where it splits into two components. An associated perineal abscess measures 9.1 cm in AP dimension x 5.1 cm CC x 1.2 cm transverse (series 701, image 33 and series 6.1, image 47). There is a second small fistula along the left aspect of the rectum at the 1 o'clock position (series 301, image 32) that does not extend to the skin surface or have an associated fluid collection.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a small amount of pelvic free fluid. There is a oval 2.0 x 1.6 cm (series 506, image 368) presacral structure on the left that is non-enhancing and intermediate on T1 and T2 weighted images with restricted diffusion. This may represent an enlarged, likely reactive, presacral lymph node.
A fistula and abscess extends from the right lateral rectal wall to the base of the scrotum. There is a second small fistula along the left rectal wall with no associated abscess.