History of rectal cancer. Epic note dated 5/20/2016 speaks of a rectosigmoid cancer 12 cm from the anal vertex presenting with obstruction with transverse loop colostomy and chemotherapy. PELVIS:UTERUS, ADNEXA: Anteverted uterus. The endometrium/endometrial canal is normal in thickness. The inner myometrium/junctional zone is poorly delineated but is normal in thickness. The parametrial soft tissues are unremarkable. The adnexa are atrophic and poorly visualized. See discussion below regarding vaginal fistula. BLADDER: Partially distended urinary bladder without a focal abnormality.LYMPH NODES: Enhancing 8 x 8 mm lymph node in the posterior right external iliac chain (series 1 301/6 22). Additional punctate pelvic lymph nodes are not pathologically enlarged.BOWEL, MESENTERY: There is mild diffuse thickening of the rectum. At the level of the upper rectum/rectosigmoid junction there is focal narrowing, mural irregularity and mild perirectal fat spiculation which likely corresponds to the patient's known rectosigmoid/upper rectal cancer measuring approximately 1.6 x 1.6 cm (series 1301/563). This is adjacent to the presacral fluid collection with a presumed poorly delineated fistulous communication (series 701/55). BONES, SOFT TISSUES: Thick walled presacral fluid collection measuring 2.4 x 1.9 cm with a fistula tract extending caudally along the right mesorectal fat/fascia where it communicates with the right vaginal fornix. The collection abuts the rectosigmoid junction with the colon which appears tethered narrowed and spiculated. Communication with the large bowel is suspected. There is no upstream colonic dilatation to suggest underlying bowel obstruction.OTHER: No significant abnormality noted.
1.Posttreatment changes of the upper rectum/rectosigmoid junction with a 1.6 x 1.6 cm region of mild enhancement and perirectal fat spiculation, compatible with residual tumor. 8 x 8 mm right external iliac enhancing lymph node.2.An adjacent presacral fluid 2.4 x 1.9 cm collection is compatible with an abscess with a fistulous communication with the right vaginal fornix and likely the adjacent rectosigmoid colon. 