Large-volume late-onset pelvic fluid collection after ileal pouch-anal anastomosis
✍ Scribed by Ling Shen; Lei Lian; Victor W. Fazio
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 79 KB
- Volume
- 15
- Category
- Article
- ISSN
- 1078-0998
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✦ Synopsis
Pouch-anal Anastomosis
To the Editor:
Ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice in patients with ulcerative colitis (UC) or familial adenomatous polyposis who require colectomy. While IPAA significantly improves patients' health-related quality of life, a variety of mechanical, inflammatory, and functional complications can arise after this procedure, such as pouchitis, Crohn's disease (CD) of the pouch, cuffitis, pouch-vaginal fistulae, and irritable pouch syndrome. 1 Here we describe 3 female patients who had restorative proctocolectomy with IPAA and developed a large-volume pelvic fluid collection more than 12 months after the ileostomy take-down.
The first case is a 39-year-old female who was diagnosed with UC in 1997. In 2003 she had subtotal colectomy with an end ileostomy for failure to medical therapy. She had not had use of infliximab before colectomy. In 2004 she had IPAA, loop ileostomy, and ileostomy take-down. Her immediate post-operative course was complicated by a leak at the tip of "J" of her pouch and pelvic abscess. The abscess was drained with a catheter. She later developed perianal abscesses and incision and drainage were performed. Based on her clinical presentations and endoscopic and radiographic findings, she was diagnosed with CD of the pouch. She was treated with scheduled doses of infliximab at 5 mg/kg/day q 2 months, together with 6 mercaptopurine, ciprofloxacin, and tinidazole. In February