75-year-old male with lower back pain that is followed by increased stool frequency, evaluate for active small bowel inflammation from Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is once again mild irregularity of the central intrahepatic biliary ducts appearing similar to prior, though this examination is not tailored for examination of the bile ducts. There is cholelithiasis without specific evidence of cholecystitis.SPLEEN: Splenomegaly, measuring up to approximately 17 cm in the cranial caudal dimension.PANCREAS: The previously described multiloculated cystic lesion in the uncinate process of the pancreas (series 3, image 18) measures approximately 1.1 x 1.4 cm, previously 1.1 x 1.4 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference upper abdominal retroperitoneal lymph node (series 15, image 18) measures 3.9 x 1.3 cm, previously 3.9 x 1.3 cm. Other non and extrahepatic peritoneal lymph nodes appear similar to the prior examination.BOWEL, MESENTERY: There is increased fibrofatty proliferation involving the jejunum. Postsurgical changes of ileal resection are present. There is narrowing and decreased distensibility involving an approximately 10 cm segment of the distal neoterminal ileum without evidence of associated upstream obstruction. There is no associated bowel wall thickening, increased mucosal enhancement, or other signal abnormalities to suggest active inflammation.BONES, SOFT TISSUES: Degenerative changes affect the spine particularly the lower thoracic spine. Postsurgical changes are present in the anterior abdominal wall.OTHER: No significant abnormality noted.
1.Postsurgical changes of prior ileal resection.2.Non-flow limiting chronic stricturing of approximately 10 cm segment of presumed neoterminal ileum without evidence of active inflammation.3.Grossly stable appearance of the biliary tree compatible with history of sclerosing cholangitis. Cirrhotic liver. Splenomegaly.4.Grossly stable cystic lesion in the uncinate process of the pancreas which most likely represents an IPMN. 5.No significant interval change in retroperitoneal lymphadenopathy.6.Apparently new 1.7 cm sclerotic focus within the left ilium which may represent a benign bone island but would be better characterized on dedicated CT or MRI if clinically indicated.