A case of refractory pouchitis leading to cardiopulmonary arrest

The patient, a man in his 40 s, underwent total colectomy 14 years after the onset of refractory ulcerative colitis. One year postoperatively, he developed recurrent pouchitis. At admission of the patient to the hospital with anorexia and vomiting, acute kidney injury was noted. After admission, the patient was diagnosed with pouchitis and secondary to ileal pouch dysfunction. After administration of ciprofloxacin (800 mg/day), the patient's symptoms improved temporarily, but the disease relapsed shortly thereafter. Although he resumed oral intake 9 days after the relapse, vomiting occurred the following day. Abdominal computed tomography revealed fluid retention within the gastrointestinal tract. As a result of prolonged fluid retention in the gastrointestinal tract and impaired absorption because of intestinal edema, the patient remained in hypovolemic shock. Cardiopulmonary arrest occurred the day after the relapse. Systemic status and response to therapy must be evaluated carefully in severe cases of pouchitis with unstable general condition. Such evaluation can indicate appropriate timing of surgical intervention, including stoma reconstruction, instead of persistence with conservative treatments using modalities such as antimicrobial agents. Early recognition of risks of severe disease and prompt intervention are crucially important for improving clinical outcomes.