Gastric pouch interposition between ileum and anus after total proctocolectomy

After a total proctocolectomy for familial adenomatous polyposis or for ulcerative colitis, an ileal pouch-anal anastomosis is not possible in some circumstances. In case of Crohn's disease (CD), an ileal pouch-anal-anastomosis is contraindicated by most authors. We have devised a means to avoid a permanent ileostomy in these situations. It consists of transposing between ileum and anus the left half of the vertical part of the stomach, in the shape of a pouch vascularized through the right gastroepiploic pedicle. This plasty was performed on a 35-year-old female after a proctocolectomy for CD. There was no post-operative complication. The functional results remained satisfactory after 9 months: two to five stools per 24 h, no urgency, occasional seepage during night. The main disadvantage was the necessity of high dose proton pump inhibitor therapy to prevent anal burning sensation.