Salvage Operation for Secondary Pouchitis in Post-operative Patient with Ulcerative Colitis: Report of a Case and Review of the Literature

Yuji Toiyama, Toshimitsu Araki, Shigeyuki Yoshiyama, Naoko Sakamoto, Chikao Miki and Masato Kusunoki

The Second Department of Surgery, Mie University School of Medicine

Secondary pouchitis is defined as a mucosal inflammatory lesion in the ileal reservoir, that is provoked by pouch-related complications following a total colectomy and ileal pouch anal anastomosis. We report a case of secondary pouchitis that was successfully treated by salvage surgery. A 20-year-old woman with ulcerative colitis developed an acute, severe bloody diarrhea following a proctocolectomy, ileal pouch anal-canal anastomosis and diverting ileostomy. She was diagnosed as having secondary pouchitis arising from a peripouch abscess, apical bridge or blind loop formation. The remnant rectum and ileal pouch were excised, and a new ileal pouch-anal anastomosis and diverting ileostomy were made. The patient's postoperative course was uneventful, and she has shown no further signs of pouchitis. Salvage surgery may be a valuable treatment for treating secondary pouchitis when the pouchitis is caused by surgery-related complications.

Key words
ulcerative colitis, secondary pouchitis, salvage operstion

Reprint requests
Yuji Toiyama The Second Department of Surgery, Mie University School of Medicine 2-174 Edobashi, Tsu, 514-8507 JAPAN

Accepted
April 30, 2003

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