28-year-old man with history of Crohn's status post ileocecectomy 8/2016, now presents with right lower quadrant phlegmon and pneumaturia. ABDOMEN:LIVER, BILIARY TRACT: Poor signal in the dome of the liver. A few subcentimeter cysts are noted in the right lobe, otherwise the liver is normal in signal and morphology.No intra or extrahepatic biliary ductal dilatation. The gallbladder appears normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 6 mm cyst in the left renal midpole, otherwise the kidneys appear normal. There is mild prominence of the right renal collecting system and ureters. There is inflammation in the bowel and mesentery adjacent to the mid and distal right ureter.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Multiple thickened, enhancing loops of small bowel are seen predominantly in the right lower quadrant near the anastomotic site from prior ileocecectomy. Mild diffusion restriction within these loops indicates acute inflammation. There is a moderate amount of interloop fluid. There is a stellate fluid collection in the right lower quadrant with thick enhancing wall (1801/62) which appears to extend between loops of small bowel and to the dome of the bladder measuring approximately 55 x 43 mm. Additionally, there is an apparent ~2 cm tract communicating (1601/27) between small bowel loops and the right bladder dome.Of note, the transverse, descending, and rectosigmoid colon appear relatively normal.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Nondependent susceptibility artifact in the bladder indicates intraluminal air. In the right lateral dome of the bladder, there is an approximately 33 mm broad-based area of serosal and intramural thickening and enhancement. Within this area, there is an apparent tract (described above) which appears to traverse the wall of the right dome of the bladder (1801/48).LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
1.Acutely inflamed small bowel loops, predominantly in the right lower quadrant near the proximal anastomosis with interloop fluid suspicious for Crohn's flare.2.Stellate shaped collection of fluid with enhancing wall which is suspicious for network of enteroenteric fistulae versus interloop abscess (area present on prior preoperative CT imaging, increased).3.Possible enterovesicular fistula tract involving the right dome of the bladder.