46 year old female with history of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: 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: Postoperative changes of partial colectomy and proctectomy with left lower quadrant end colostomy. There is a 9 cm portion of neoterminal ileum demonstrating moderate wall thickening and mucosal hyperenhancement compatible with acute on chronic disease which is relatively stable compared to prior Additionally, the distal 15 cm of colon demonstrates marked wall thickening and mucosal hyperenhancement, also compatible with acute on chronic disease.A colocutaneous fistula is seen at the level of the ostomy arising from the 12:00 position of the distal colon measuring 9mm in maximal axial width (image 84 of series 15).Enhancing fistulous tracts are seen arising from the superficial enteric rectum at the 3, 4, and 10 o'clock positions forming multiple branches which terminate in bilateral gluteal clefts. A seton appears to be present in one of these fistulae.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: Postoperative changes of partial colectomy and proctectomy with left lower quadrant end colostomy. There is a 9 cm portion of neoterminal ileum demonstrating moderate wall thickening and mucosal hyperenhancement compatible with acute on chronic disease which is relatively stable compared to prior Additionally, the distal 15 cm of colon demonstrates marked wall thickening and mucosal hyperenhancement, also compatible with acute on chronic disease.A colocutaneous fistula is seen at the level of the ostomy arising from the 12:00 position of the distal colon measuring 9mm in maximal axial width (image 84 of series 15).Enhancing fistulous tracts are seen arising from the superficial enteric rectum at the 3, 4, and 10 o'clock positions forming multiple branches which terminate in bilateral gluteal clefts. A seton appears to be present in one of these fistulae.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Acute on chronic Crohn's disease in the distal 15 cm of colon and distal 9 cm of neoterminal ileum as above, unchanged from prior.2. Colocutaneous fistula at the level of the left lower quadrant ostomy appearing similar to prior.3. Complex perianal fistulas, however are suboptimally evaluated on this study. 