22-year-old female with small bowel Crohn's disease status post stricturoplasty. Now with pain and obstructive symptoms.Additional history from medical record: As a sophomore in high school had abdominal pain and vomiting, and underwent small bowel stricturoplasty of 5 strictures. Senior year of high school had rectal abscess that ruptures and caused sepsis. Had setons placed at that time. Had abscess that ruptured, went into septic shock. Had setons placed (still have 4 years later) 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: Scattered prominent mesenteric lymph nodes are present.BOWEL, MESENTERY: Four definite areas of small bowel stricturing are identified, with a possible fifth area. Three of these areas demonstrate enhancing wall thickening, luminal narrowing, and proximal bowel wall dilation suggestive of acute on chronic disease. The longest of these areas is in the distal small bowel in the upper abdomen at midline (series 10, image 31) spanning approximately 8.5 cm. The second area just distal to this in the right hemiabdomen (series 10, image 28) spans approximately 3 cm. The third area in the central abdomen at midline (series 10, image 31) spans approximately 5 cm.A 4-5 cm region in the distal ileum closer to the ileocecal valve demonstrates wall thickening and luminal narrowing without definite wall enhancement (series 10, image 24). A questionable area of collapsed bowel in the right lower quadrant may represent the fifth site of stricturing, also without definite wall enhancement to suggest acute disease.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered prominent mesenteric lymph nodes are present.BOWEL, MESENTERY: Multifocal areas of enhancing wall thickening and luminal narrowing, as described above. BONES, SOFT TISSUES: The perineal region is incompletely imaged, however, two tracts are seen extending from the rectum to the right aspect of the gluteal cleft, likely reflecting the patient's known fistula tracts. No definite associated drainable fluid collection is identified on this limited evaluation.
1.Multifocal areas of persistent small bowel wall thickening and stricturing. At least four discrete sites are seen, three of which demonstrate enhancement, consistent acute on chronic inflammation. A questionable fifth site of ileal stricturing is suggested in the right lateral abdomen.2.Fistulous tracts incompletely imaged in the right perianal region, without definite associated drainable fluid collection.