Complications of the Pelvic Pouch
6 results
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Benign Disease- A 39-year-old woman with a history of long-standing ulcerative colitis (UC) undergoes an elective total proctocolectomy and ileoanal pouch anal anastomosis (IPAA). Two months postoperatively, she reports a persistent low-grade fever, dyspareunia, vaginal air, and mucopurulent rectal drainage. A gastrografin pouch study demonstrates a pouch vaginal fistula. What is the most likely etiology?
- A 54-year-old man with a history of inflammatory bowel disease (IBD) has a 3-stage total proctocolectomy with ileal pouch-anal anastomosis (IPAA) 9 years prior. He notes that there was a long delay between his second and third stage surgery. He has had significant diarrhea, fecal incontinence, and pelvic pain for years despite multiple medical therapies, including ciprofloxacin, steroid enemas, and rifaximin. He says he has never had good pouch function. What is the most likely cause of his current clinical condition?
- A 34-year-old otherwise healthy woman, who underwent total abdominal colectomy with end ileostomy 1 year ago for fulminant Crohn’s disease colitis, presents to the office with ongoing bloody mucoid discharge per rectum and tenesmus. On examination, her abdomen is unremarkable with end ileostomy. Ileostomy is healthy and pouches well. Rectal examination is remarkable for normal perineal skin, normal tone, and absence of fistula and fissure. She has been through four different biologics. Endoscopy shows deep ulcers in the rectum with mucosal friability. She has bothersome mucoid anal discharge multiple times per day and wishes to know whether this can be resolved. Her small bowel disease was previously active and is now quiescent on entyvio. What is the best next option in her management?
- Eight days after ileal-pouch anal anastomosis (IPAA) and diverting loop ileostomy, your patient presents to the emergency department with pelvic pain, low-grade fever, and purulent drainage per anus. The patient is hemodynamically stable with a white blood cell (WBC) count of 14. Intravenous (IV) antibiotics and fluids are initiated. Computed tomography (CT) with rectal contrast reveals a deep pelvic abscess with contrast extravastion into the cavity. What is the best next step in the management of this patient?
- A 48-year-old man with a history of ulcerative colitis (UC) underwent the closure of a diverting ileostomy following an open restorative proctocolectomy with the creation of a J-pouch. Three weeks following stoma closure, he develops enteric drainage from his midline surgical-site, and computed tomography (CT) demonstrates a fistula tract from the tip of the J pouch. This drainage persists after an additional 4 weeks of observation. What is the most appropriate next step in management for this patient?
- A 24-year-old man with history of ulcerative colitis (UC) is 3 days status postemergent subtotal colectomy with end ileostomy for toxic megacolon. He has a low-grade fever of 38.0 °C, rising heart rate to the 110s, rising leukocytosis to 15 x 109, and lower pelvic pain and pressure. Computed tomography (CT) of the abdomen and pelvis demonstrates abscess with fluid and gas adjacent and superior to the rectal stump staple line. How could the chance of complication have been reduced?