RADIOLOGY: GASTROINTESTINAL: GI: Case# 33003: CROHNS DISEASE, VAGINAL FISTULA AND ABSCESS. 34-year-old black female transferred from an outlying hospital presents with a rectovaginal fistula on physical exam. The patient is complaining of abdominal pain, increased distention, nausea and vomiting, and diarrhea with feces coming from the vagina. The patient is febrile with an elevated white count. 1. A large amount of ascites with enhancing peritoneum and thickening of the small bowel walls which is consistent with peritonitis. 2. Thickening of the small bowel and colon and the presence of a rectovaginal fistula and deep anal ulcer is consistent with Crohns disease. 3. Collection of extraluminal air between loops of ileum which could represent either perforation of the small bowel or a fistulous connection between the loops of small bowel in the right lower quadrant. 5. Left-sided pleural effusion with overlying lung consolidation consistent with left lower lobe atelectasis versus early pneumonia.