20-year-old male with history of ulcerative colitis and perianal fistulas status post seton placement for ischiorectal abscesses with incision and drainage. Evaluate. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of proctocolectomy with ileal pouch-anal anastomosis, which appears intact. The inflammatory changes noted at the pouch previously have improved.BONES, SOFT TISSUES: There are 2 complex transsphincteric fistulas with setons in both fistulas. The right sided fistula tracks from 9:00 position, extends transphincterically, and branches into a tract extending anteriorly and posteriorly. The posterior tract extends inferiorly and exits at the right gluteal cleft. The anterior tract extends into the ischiorectal fossa and terminates at that location. There is evidence of a drain in the right ischiorectal fossa.The left-sided fistula tracks from approximately 2:00 position, extends transsphincterically, and branches into a tract extending anteriorly and posteriorly. The posterior tract extends inferiorly and exits at the left gluteal cleft. The anterior tract extends into the ischiorectal fossa without measurable fluid collection.There is additionally increased T2 signal with evidence of enhancement within the perineal region bilaterally consistent with granulation tissue.No pelvic abscess is identified.OTHER: No significant abnormality noted.
1.Complex bilateral transsphincteric fistulas as described above with evidence of extensive perineal granulation tissue.2.Postoperative changes of proctocolectomy with intact ileal pouch-anal anastomosis.