27 year old female patient with recurrent severe sepsis of uncertain source, perianal Crohn's disease status post seton drainage x 3. Unknown if all infectious sources have been drained. Evaluate for perianal/perirectal abscess, fistulae between pelvic organs, and other other infectious sources. 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: There is wall thickening and enhancement of the rectosigmoid colon compatible with active inflammation. There colon proximal to this point is distended with stool. The terminal ileum is unremarkable. There is a suprasphinteric fistula extending from the 6 o'clock position of the rectum to the left ischioanal fossa which demonstrates complex branching and extends across midline to the right side. There is a small abscess/fluid collection measuring 1.9 x 0.7 cm (image 86, series 5) within the right ischioanal fossa just lateral to the puborectalis muscle. Furthermore, there is a more discrete abscess within the left ischioanal fossa measuring 1.4 x 1.1 cm (image 35, series 1602). At least two other perianal fistulae are identified on the right and left with setons in place.BONES, SOFT TISSUES: There is edema type signal within the posterior thorax and right thigh subcutaneous tissues. OTHER: There is no abnormal intra-abdominal fluid collection.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As described above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is no abnormal intra-pelvic fluid collection.
1.Complex, branching perianal fistulae with a left suprasphinteric fistula and at least two small bilateral perianal fistulae.2.Right ischioanal fluid collection and more discrete left ischioanal abscess. 3.Wall thickening and enhancement of the rectosigmoid colon compatible with active inflammation.