Reason: 69-year-old female with h/o ileocolonic Crohn's disease, s/p multiple SBR with short bowel, admitted with diarrhea and weight loss. Please evaluate for active Crohn's disease. ABDOMEN:LUNG BASES: Left pleural effusion and atelectasis/consolidation at the left lung base appearing similar to recent chest radiograph.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: Large hiatal hernia.Postsurgical changes from an ileocecectomy. Overall there is a paucity of distal small bowel loops related to prior ileal resection. The residual small bowel is well-distended with oral contrast. The neoterminal ileum is clearly identified. The bowel is normal in caliber and wall thickness. There is no abnormal postcontrast enhancement or restricted diffusion. No significant fibrofatty proliferation or mesenteric lymphadenopathy. No fixed luminal narrowing or prestenotic/upstream dilatation. No sinus tract or fistula formation. No significant free fluid or loculated fluid collection.Previously seen inflammatory changes involving the colon are no longer seen.BONES, SOFT TISSUES: Patchy marrow signal intensity, not significantly changed. Areas of increased T1 and T2 signal within the spine compatible with hemangiomas. Multiple compression deformities in the thoracic and lumbar spine are incompletely assessed but appear grossly similar to the prior exam.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: Patchy marrow signal intensity is not significantly changed.There is mildly increased enhancement along the anus and adjacent intergluteal cleft, and a perianal fistula at the 12:00 position cannot be excluded (images 63 to 80 series 17).OTHER: Nodular soft tissue signal material immediately anterior to the sacrum which is nonspecific but appears grossly stable since 2006 CT and thus is likely of benign etiology.
1.Paucity of small bowel related to previous resection without evidence of active inflammation within the small and large bowel.2.Increased enhancement along the anus and intergluteal fold, nonspecific; correlation with patient's clinical history and physical exam recommended as a perianal fistula at the 12:00 position cannot be excluded.3.Heterogeneous bone marrow appearing grossly similar to prior. However, if there is clinical concern for metastatic disease, additional imaging such as a nuclear medicine bone scan may be considered as clinically warranted.