[Transsacral fistula of an ileal pouch-anal anastomosis]

For patients with ulcerative colitis and familial adenomatous polyposis the restorative proctocolectomy with ileo-anal-pouch anastomosis is the surgical treatment of choice. Leakage from the ileo-pouch anastomosis is the surgical treatment of choice. Leakage from the ileo-pouch-anastomosis can be a difficult to manage complication, which in some cases resists all attempts at local repair. A surprising complication of a 28 years old woman patient with an ileo-anal-pouch anastomotic fistula is presented. The fistula developed the 4th day postoperatively. Local irrigation and transanal drainage seemed to have a good result, the patient being examined after two weeks. During an apparently better evolution, after one month, the patient developed a transsacral fistula with local abscess and osteolysis. The ileo-anal-pouch anastomosis was converted to a less comfortable conventional ileostomy, but with good local and general final result.