A rare case of refractory pouchitis requiring ileal J-pouch excision after total proctocolectomy for ulcerative colitis
| Autor: | Akiko Ichihara, Takashi Wada, Atsushi Nanashima, Masato Nishimuta, Takuto Ikeda |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry Abdominoperineal resection medicine.medical_treatment Pouchitis Enema Anastomosis medicine.disease Ulcerative colitis Surgery 03 medical and health sciences Metronidazole 0302 clinical medicine 030220 oncology & carcinogenesis Medicine 030211 gastroenterology & hepatology Pouch business Complication medicine.drug |
| Zdroj: | International Journal of Surgery Open. 24:8-11 |
| ISSN: | 2405-8572 |
| DOI: | 10.1016/j.ijso.2020.02.001 |
| Popis: | Introduction Pouchitis is a late-period complication after ileal pouch-anal (canal) anastomosis in patients with ulcerative colitis (UC). Most pouchitis is controlled with the antimicrobial agents. However, some postoperative pouchitis does not respond to antimicrobial agents, and it is very difficult to treat cases of refractory and severe pouchitis. Presentation of case A 66-year-old man underwent total proctocolectomy with ileal pouch-anal anastomosis 22 years ago. He repeatedly presented pouchitis over the last five years. The administration of antimicrobial agents had not been effective, and he sustainably suffered from stenosis symptoms at the ileal pouch-anal anastomosis site. Therefore, we decided to excise the diseased ileal pouch by permanent ileostomy according to technique of abdominoperineal resection. The postoperative course was uneventful, and at 6 months after resection, there was no relapse of abdominal symptoms and he reported a better quality of life. Discussion The cause of pouchitis is still unknown. Oral administration of antimicrobial agents, such as metronidazole and ciprofloxacin are effective for almost pouchitis, but there are some patients of refractory pouchitis. In the cases of refractory pouchitis, the 5-ASA formulation, a steroid enema, immunomodulators, biologics, and plasma pheresis are used. But, despite attempts with these various treatments, there are rare cases that require surgical intervention to excise the diseased ileal pouch. Conclusions We should consider surgical intervention for severe refractory pouchitis after ileal pouch-anal (canal) anastomosis for UC. |
| Databáze: | OpenAIRE |
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