ABSTRACT
BACKGROUND:
Pouch-related
complications (PRCs), such as pelvic
abscesses and perianal complex
fistulas, can occur after ileal pouch-anal anastomosis (IPAA) in
ulcerative colitis (UC). They are often difficult to treat and require salvage
surgery. We
report two cases of PRC associated with
fistulas. CASE PRESENTATION First case A 38-year-old man was diagnosed with UC at age 26 years. Four months after the
diagnosis of UC, the
patient underwent
hand-assisted laparoscopic
restorative proctocolectomy, IPAA, and
ileostomy for acute fulminant UC. Two years after the closure of the
ileostomy, the
patient developed a perianal
abscess and underwent
ileostomy reconstruction. He was referred to our department at 35 years of age, because his symptoms did not improve despite repeated seton
drainage of a complicated perineal
fistula. We diagnosed PRC with a pelvic
abscess and complicated pouch
fistula and performed salvage
surgery. This
diagnosis was revised to
Crohn's disease. SECOND CASE A 50-year-old man was diagnosed with UC at age 18 years and was administered high doses of
steroids; however, his symptoms did not improve. He underwent
restorative proctocolectomy, IPAA, and
ileostomy at another
hospital. The
ileostomy was closed, and his condition stabilized thereafter. At 35 years of age, perianal
pain developed, and he was diagnosed with a complicated pouch-perineal
fistula. A
fistula was observed near the staple line of the ileal end closure on the
head side of the pouch. Reconstruction of the
ileostomy and seton
drainage were performed; however, his symptoms did not improve, and he was referred to our
hospital. We diagnosed PRC with a pelvic
abscess and a complicated pouch
fistula and performed salvage
surgery. The resected specimen showed
strictures in two locations at the oral site of the afferent
limb (at the pouch) and at the IPAA. Both
patients returned to society and are currently
outpatients.
CONCLUSIONS:
We encountered two cases of PRC after IPAA that did not improve with seton
drainage or
ileostomy. Pouch resection was performed after considering the
patient's
quality of life and reintegration into society.