Ileal Pouchitis With Endoscopic Pictures

Abstract

Ulcerative colitis (UC) is an inflammatory disorder, and almost one-third of UC patients ultimately undergo surgical interventions because of complications or refractory disease. Current restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard intervention for severe chronic UC with refractory disease. Several complications associated with this procedure can occur, including anastomotic leak, sepsis, and pouch ischemia. The most frequent long-term complication is pouchitis, an idiopathic inflammatory condition involving the ileal pouch. Presentations may vary but include stool frequency, urgency, incontinence, fatigue, malaise, and fever, less commonly bloody stools. We report a case of ileal pouchitis in a young patient, two years after proctocolectomy with IPAA responsive to antibiotic treatment. Our case supports that imaging studies like flexible sigmoidoscopy are necessary to rule out other disorders in patients with pouchitis.

Keywords: ileal pouchitis; pouchitis; ulcerative colitis.

Figure 1. Pouchitis after ileal pouch-anal anastomosis (J-pouch) in ulcerative colitis (white arrows showing erythema).