Pouchitis and pre-pouch ileitis developed after restorative proctocolectomy for ulcerative colitis: a case report

Area of Science:

• Gastroenterology
• Surgical Gastroenterology

Background:

• Ulcerative colitis (UC) is a chronic inflammatory bowel disease.
• Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical option for UC.
• Pouchitis, inflammation of the ileal pouch, is a common complication after IPAA.

Observation:

• A 35-year-old female developed fever and abdominal pain post-IPAA.
• Computed tomography revealed fecal impaction in the pouch and proximal ileum.
• Endoscopic examination showed inflammation in the pouch and pre-pouch ileum.
• Elevated mucosal cytokine production was noted in affected areas.

Findings:

• The patient was diagnosed with pouchitis and pre-pouch ileitis.
• Treatment with antibiotics and corticosteroids resolved symptoms, endoscopic inflammation, and reduced cytokine levels.
• Fecal stasis and bacterial overgrowth were identified as the major pathogenic factors.

Implications:

• This case highlights fecal stasis and bacterial overgrowth as key contributors to pouchitis and pre-pouch ileitis.
• Effective management involves addressing fecal stasis and employing antibiotic and corticosteroid therapies.
• Further research into preventing fecal stasis post-IPAA may improve patient outcomes.