33-year-old female, status post laparoscopic total proctocolectomy for Crohn's disease. Status post ileostomy takedown and intravesical fistula repair of bladder in 10/09. Persistent pelvic pain with periodic drainage. Evaluate for abscess or other abnormality. ABDOMEN:LUNG BASES: Clear lung bases. No infiltrates, nodules or effusions.LIVER, BILIARY TRACT: Cholelithiasis. No biliary duct dilatation or obstruction. The anterior branch of the right portal vein is patent and the previous noted portal vein thrombosis has resolved. Otherwise, hepatic vasculature remains patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes status post total proctocolectomy and end ileostomy in the right lower quadrant. Moderate amount of soft tissue inflammation and fat stranding surrounding the ileostomy site has resolved. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: New 2.2 cm diameter left adnexal cyst has an enhancing rim at image 117 of series 3. This may represent a small abscess that can be imaged with transvaginal ultrasound or pelvic MRI, if indicated. This uniloculated cyst may be physiologic, as there is no adjacent fat stranding, excess free fluid or lymphadenopathy. BLADDER: Moderate thickening of the posterior bladder wall is likely postoperative status post takedown of the iliovesicular fistula with bladder wall repair.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The presacral percutaneous right pelvic drain has been removed. No acute abnormality was found. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
1. Percutaneous pigtail drain in presacral region has been removed. New left adnexal cyst has an enhancing rim. Transvaginal ultrasound or pelvic MRI exam may be helpful for further evaluation. 2. Thrombosis of the anterior branch of the right portal vein has resolved. Cholelithiasis. 3. Otherwise, stable postoperative changes.  