Ulcerative colitis with severe backwash ileitis successfully treated by staged operation without sacrificing any involved ileum.

Extension of the inflammatory process to the terminal portion of the ileum in patients with ulcerative colitis is commonly known as backwash ileitis (BWI). To the best of our knowledge, few studies of severe BWI have been reported in the English literature, and surgical strategies for this disease have not been discussed. We report 2 patients with ulcerative colitis and severe BWI, with concomitant ileal bleeding and perforation. In both cases, staged operation without sacrificing the involved area of the terminal ileum led to ileal pouch-anal anastomosis, with a favorable postoperative outcome. Our cases suggest that the underlying pathophysiologic conditions in BWI may be reversible, and the involved lesion can be salvaged in some cases.