History of Crohn's disease status post multiple surgeries at outside hospital with ileostomy and mucous fistula complicated by multiple obstructive episodes. Stricture at anal canal and ileostomy. 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: The small bowel is relatively well distended with oral contrast. There is a paucity of small bowel compatible with history of multiple small bowel resections. Note is made of a right lower quadrant ileostomy and mucous fistula.In the left hemiabdomen there is an approximately 8 cm (series 401/11) long segment of proximal small bowel which demonstrates mild distention with moderate circumferential wall thickening, mild T2-weighted weighted hyperintensity, restricted diffusion and enhancement compatible with active inflammation. Distally it is associated with a clover-leaf appearance of adjacent small bowel loops which are tethered together suspicious for a complex fistulous network (series 401/12). This also involves the adjacent mucous fistula which demonstrates similar diffuse signal intensity compatible with active inflammation.There is mild circumferential T2-weighted mildly hyperintense wall thickening of the ileostomy loop compatible with active inflammation involving approximately 5 cm.No fixed luminal narrowing or associated upstream/prestenotic dilatation is identified to suggest a flow-limiting stricture. No significant free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: T2-weighted hyperintense peri-anal fistulous tract extending cranially and dorsally towards the coccyx and anteroinferiorly towards the scrotum with probable seton catheter in place. No associated fluid collection. Additionally, there is T2 weighted mildly hyperintense tract extending along the left perianal region in the ischioanal fossa towards the left gluteal cleft without a discrete fluid collection.OTHER: No significant abnormality noted.
Active inflammation of the mucous fistula, an approximately 8 cm proximal small bowel loop in the left hemi-abdomen and approximately 5 cm of the ileostomy loop. No flow-limiting stricture is identified. Complex fistulous network involving the proximal small bowel loop, adjacent small bowel loops and mucous fistula in the left hemi-abdomen.Peri-anal fistulous disease as described above is incompletely evaluated. No associated abscess is seen. 