A Case of Ulcerative Colitis Requiring Excision of the Ileal J-pouch due to Refractory pouchitis

• Published in: Nippon Daicho Komonbyo Gakkai Zasshi Vol. 59; no. 2; pp. 86 - 90
• Main Authors: Watanabe, K., Funayama, Y., Fukushima, K., Shibata, C., Takahashi, K., Saijo, F., Nagao, M., Haneda, S., Kudoh, K., Kyoama, A., Kinouchi, Y., Sasaki, I.
• Format: Journal Article
• Language: English
• Published: The Japan Society of Coloproctology 2006
• ISSN: 0047-1801; 1882-9619
• DOI: 10.3862/jcoloproctology.59.86

Pouchitis is one of the frequent complications after ileal pouch-anal (canal) anastomosis for patients with ulcerative colitis. Its etiology is unknown but conservative therapy such as antimicrobiotics is effective for most cases. However, some cases with refractory chronic pouchitis have been reported recently. Here we report a case with ulcerative colitis complicated with refractory pouchitis and requiring excision of the pouch. The patient was a 67-year-old male with ulcerative colitis treated by ileal J-pouch-anal canal anastomosis. After closure of the loop ileostomy, frequent mucous stools (30 times a day) occurred. Medical treatment was not effective and we performed end ileostomy to exclude the ileal j pouch. The symptom of frequent defecation improved but 5 months after the exclusion, severe pouchitis occurred. Conservative therapy was not effective and the symptom deteriorated. Fifteen months after the exclusion, we performed resection of the ileal j pouch and constructed the end ileostomy. From the histopathological findings of the specimen of the colon and ileal J-pouch, Crohn's disease, indeterminate colitis, and Cytomegalovirus infection were ruled out. Postoperative course was uneventful for two years. In conclusion, pouchitis must be taken into account as one of the important complications after ileal pouch-anal anastomosis for ulcerative colitis.