58-year-old female with a concern for enterovaginal fistula and possible pelvic mass. Also infection outside/tracking to duodenum. ABDOMEN:LIVER, BILIARY TRACT: Again seen is a heterogeneous encapsulated collection, with peripheral enhancement in the posterior inferior perihepatic region with extension into Morrison's pouch, appearing similar to the prior study, measuring 6.0 x 3 .6 cm, previously 5.7 x 3.8 cm (70; series 1701). There is associated restricted diffusion consistent with abscess formation. There is linear increased T2 signal abnormality with associated enhancement originating from the superolateral aspect of the proximal 2nd portion of the duodenum which extends to the aforementioned abscess in the right upper quadrant consistent with fistula formation.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion.PELVIS:UTERUS, ADNEXA: The previously described foci of gas density, interposed between the anterior rectum and vagina appears to represent air within the vaginal cuff. No convincing evidence of fistula formation.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Right upper quadrant abscess with apparent fistula formation with the 2nd portion of the duodenum as detailed above. These findings may represent the sequela of a perforated duodenal ulcer and clinical correlation is indicated.2.No evidence of enterovaginal fistula as clinically questioned. The previously described air interposed between the vagina and rectum is not definitively visualized on today's examination and may represent air within the vaginal cuff which can be related to prior pelvic physical examination or instrumentation.