28 year-old male with a history of Crohn's disease and enterovesical fistula. Presents with suprapubic pain and stool in the urine. 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: There is increased T2 signal abnormality, wall thickening and enhancement of the terminal ileum, measuring approximately 10 cm in length. Additionally, there is complex fistula formation in the right lower quadrant with foci of enhancing linear increased T2 signal abnormality extending from the terminal ileum to involve the sigmoid colon, as well as extending to additional portions of the distal ileum. These findings are consistent with enterocolonic and enteroenteric fistula formation. There is loculated interloop fluid in the right lower abdomen immediately adjacent to the aforementioned matted and tethered loops of small bowel.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Asymmetric thickening of the bladder wall is nonspecific, but may be reactive.BOWEL, MESENTERY: There is increased T2 signal abnormality, wall thickening and enhancement of a long segment of terminal ileum, measuring at least 10 cm in length. Additionally, there is a fistulous network in the adjacent area in the right lower quadrant with foci of enhancing linear increased T2 signal abnormality extending from the terminal ileum to involve the sigmoid colon, as well as extending to additional portions of the distal ileum. These findings are consistent with enterocolonic and enteroenteric fistula formation. There is loculated interloop fluid in the right lower abdomen immediately adjacent to the aforementioned matted and tethered loops of small bowel with associated peripheral enhancement or restricted diffusion suspicious for abscess formation.BONES, SOFT TISSUES: There is a focus of fluid signal intensity in the soft tissues immediately anterior to the gluteal crease, measuring 10 x 11 mm, suspicious for abscess formation. Additionally, note is made of a 9 x 10-mm focus of fluid signal intensity in the soft tissues along the right lateral base of the penis, which is also suspicious for abscess formation.
1.Findings consistent with active inflammatory bowel disease involving the distal small bowel and terminal ileum with a complex fistulous network with stellate configuration in the right lower quadrant. There are apparent entero-colonic and entero-enteric fistula formation as detailed above.2.Interloop fluid adjacent to the aforementioned fistulous network in the right lower quadrant with associated peripheral enhancement, suspicious for abscess formation. 3.Multiple small fluid collections in the soft tissues of the perineum, including the right lateral base of the penis and gluteal crease, suspicious for abscess formation, reference measurements provided above.4.Asymmetric thickening of the bladder wall nonspecific but likely reactive in etiology.