A Case of Recurrent Ulcerative Colitis with Massive Hemorrhage in the Rectal Stump after Proctocolectomy and Ileoanal canal Anastomosis

Yu Takahashi, Hiroshi Hasegawa, Seiji Ogiso, Masaya Shiomi, Masato Momiyama, Tsuyoshi Igami, Syusaku Ohira, Toshiharu Mori, Keisuke Uehara and Susumu Miyazaki

Department of Surgery, Nagoya Daini Red Cross Hospital

Proctocolectomy and ileoanal canal anastomosis (IACA) is a standard procedure for the treatment of ulcerative colitis, but problems of reccurrence and canceration of the surviving rectal tissue often occur. We report a case in which ulcerative colitis recurred accompanied by a massive hemorrhage in the surviving rectum. The patient was treated by resection of the abdominoperineum. A 21-year-old man who undergone a proctocolectomy and IACA for total ulcerative colitis in 1996 was admitted to the hospital complaining of melena and anal pain in September 1999. Two days after admission, the patient was found in hemorrhagic shock with a systolic blood pressure of 60 mmHg and 5.0 g/dl of hemoglobin after experiencing severe melena. Endoscopic diagnosis and therapy was difficult because of the severe anal pain and massive hemorrhage, so an operation was immediately performed. On entering his abdomen, a considerable number of adhesions between the ileal pouch and the pelvic wall were found. An ileoanal anastomosis and an abdominoperineal resection of the surviving rectum and ileostomy was therefore performed. The mucosa of the resected rectum was dropped out. The histopathological diagnosis was no-malignant, active phase ulcerative colitis.

Key words
ulcerative colitis, ileoanal canal anastomosis, postoperative complications

Reprint requests
Yu Takahashi National Cancer Center Hospital 5-1-1 Tsukiji, Cyuou-ku, Tokyo, 104-0045 JAPAN

Accepted
October 31, 2000

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