Case Report and Literature Review Illustrating the Clinical, Endoscopic, Radiologic, and Histopathologic Findings with Prepouch Ileitis after IPAA and Restorative Proctocolectomy for Refractory Ulcerative Colitis

Case Reports in Gastrointestinal Medicine
Christienne ShamsMitchell S Cappell

Abstract

Prepouch ileitis (PI) is an uncommon complication of ileal pouch anal anastomosis (IPAA) and restorative proctocolectomy (RPC) for treatment of refractory ulcerative colitis (UC). A case is reported of PI in a 16-year-old girl who presented with severe UC that was initially stabilized with infliximab therapy but re-presented 1 year later with severe UC, refractory to infliximab and corticosteroid therapy, which required IPAA and RPC. Her symptoms resolved postoperatively, but she re-presented 1 year later with 10 loose, bloody, bowel movements/day and involuntary 6-Kg weight-loss. Computerized tomographic enterography showed focal narrowing and mucosal enhancement of the pouch and focal narrowing, abnormal mucosal enhancement, and mural thickening of the prepouch ileum. Pouchoscopy revealed exudates and ulcerations in both the pouch and prepouch ileum up to 50 cm proximal to pouch, as confirmed by histopathology of pouch and ileal biopsies. Capsule endoscopy revealed no small intestinal lesions beyond 50 cm from the pouch. She required antibiotics, hydrocortisone enemas, and eventually azathioprine to control her symptoms. She remains asymptomatic 4 years later while chronically administered azathioprine therapy. Comprehensive ...Continue Reading

References

May 11, 2006·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·Najib Haboubi
May 11, 2006·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·A J BellR J Nicholls
Feb 6, 2007·World Journal of Gastroenterology : WJG·Takashi IwataKoichi Matsumoto
Feb 5, 2008·Acta Paediatrica·Carrie SlatterWael El-Matary
Mar 6, 2009·The American Journal of Gastroenterology·Bo ShenVictor W Fazio
Apr 18, 2009·Inflammatory Bowel Diseases·Giampaolo UgoliniMario Taffurelli
Aug 18, 2009·Inflammatory Bowel Diseases·Darrell S PardiPaolo Gionchetti
Aug 10, 2011·Inflammatory Bowel Diseases·M Barreiro-de AcostaUNKNOWN Grupo joven GETECCU
Mar 8, 2012·European Journal of Gastroenterology & Hepatology·Manuel Barreiro-de AcostaUNKNOWN Grupo Joven GETECCU
Sep 30, 2016·International Journal of Colorectal Disease·Gentilini LorenzoPoggioli Gilberto

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