Complications of the Pelvic Pouch
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Benign Disease- A 28-year-old man with a history of ulcerative colitis undergoes a total proctocolectomy with stapled ileal pouch–anal anastomosis. Six months after surgery, he presents with urgency, increased stool frequency, and bloody bowel movements. Endoscopic examination findings are shown (Figure A and B). What is the best next step in management?
- A 37-year-old woman with a history of ulcerative colitis underwent restorative proctocolectomy with the construction of a J-pouch ileoanal anastomosis 2 years ago. The patient presents to your clinic with tenesmus of 3 months’ duration, pelvic discomfort, and fecal urgency. Pouchoscopy reveals inflamed pouch mucosa, with normal prepouch ileum. Which medical therapy is the treatment of choice?
- A 58-year-old man with chronic ulcerative colitis is found to have a 3-cm mass approximately 5 cm from the anal verge on surveillance colonoscopy. Biopsies reveal moderately differentiated adenocarcinoma. On rectal examination, the mass is fixed and tethered. Staging reveals a T3N0 lesion, with no evidence of distant metastasis. The best next step in management is:
- A 35-year-old man with ulcerative colitis underwent an ileal pouch–anal anastomosis. Eight weeks after surgery, contrast enema and pouchoscopy demonstrate a normal pouch and a patent anastomosis. No leakage from the pouch was noted on radiography. He underwent an uneventful ileostomy takedown. He initially did well but 6 weeks postoperatively he presents with pelvic pain, fevers, and increased pouch output. Computed tomography of the abdomen and pelvis reveals a pelvic abscess high in the pelvis with a normal pouch–anal anastomosis. An image-guided percutaneous drain is placed and the patient is treated with antibiotics. A sinogram 6 weeks later demonstrates a persistent fistula to the pouch. What is the appropriate management for this patient?
- A 51-year-old man with a 10-year history of ulcerative colitis presents with more than 10 bloody stools per day, temperature of 100.4°F (38°C), pulse of 110 beats/min, and colonic distention on radiography with a transverse colon diameter of 6 cm. Laboratory findings include hemoglobin of 9.5 g/dL (95 g/L), erythrocyte sedimentation rate of 55 mm/h, and albumin of 2.3 g/dL (23 g/L). The patient’s abdomen is distended and diffusely tender. After 48 hours of medical treatment with steroids and broad-spectrum antibiotics, the patient’s condition remains unchanged. What is the most appropriate next step?
- Perioperative
- Pelvic Floor