Izutani Yusuke, Ogino Takayuki, Sekido Yuki, Takeda Mitsunobu, Hata Tsuyoshi, Hamabe Atsushi, Miyoshi Norikatsu, Uemura Mamoru, Mizushima Tsunekazu, Doki Yuichiro, Eguchi Hidetoshi
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan.
Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka City, Osaka, 543-0035, Japan.
Surg Case Rep. 2024 May 3;10(1):111. doi: 10.1186/s40792-024-01910-0.
Pouch-related complications (PRCs), such as pelvic abscesses and perianal complex fistulas, can occur after ileal pouch-anal anastomosis (IPAA) in ulcerative colitis (UC). They are often difficult to treat and require salvage surgery. We report two cases of PRC associated with fistulas.
First case: A 38-year-old man was diagnosed with UC at age 26 years. Four months after the diagnosis of UC, the patient underwent hand-assisted laparoscopic restorative proctocolectomy, IPAA, and ileostomy for acute fulminant UC. Two years after the closure of the ileostomy, the patient developed a perianal abscess and underwent ileostomy reconstruction. He was referred to our department at 35 years of age, because his symptoms did not improve despite repeated seton drainage of a complicated perineal fistula. We diagnosed PRC with a pelvic abscess and complicated pouch fistula and performed salvage surgery. This diagnosis was revised to Crohn's disease.
A 50-year-old man was diagnosed with UC at age 18 years and was administered high doses of steroids; however, his symptoms did not improve. He underwent restorative proctocolectomy, IPAA, and ileostomy at another hospital. The ileostomy was closed, and his condition stabilized thereafter. At 35 years of age, perianal pain developed, and he was diagnosed with a complicated pouch-perineal fistula. A fistula was observed near the staple line of the ileal end closure on the head side of the pouch. Reconstruction of the ileostomy and seton drainage were performed; however, his symptoms did not improve, and he was referred to our hospital. We diagnosed PRC with a pelvic abscess and a complicated pouch fistula and performed salvage surgery. The resected specimen showed strictures in two locations: at the oral site of the afferent limb (at the pouch) and at the IPAA. Both patients returned to society and are currently outpatients.
We encountered two cases of PRC after IPAA that did not improve with seton drainage or ileostomy. Pouch resection was performed after considering the patient's quality of life and reintegration into society.
回肠储袋肛管吻合术（IPAA）治疗溃疡性结肠炎（UC）后可能出现储袋相关并发症（PRC），如盆腔脓肿和肛周复杂性肛瘘。这些并发症往往难以治疗，需要进行挽救性手术。我们报告两例与肛瘘相关的PRC病例。
第一例：一名38岁男性在26岁时被诊断为UC。诊断为UC四个月后，患者因急性暴发性UC接受了手辅助腹腔镜全直肠系膜切除术、IPAA和回肠造口术。回肠造口关闭两年后，患者出现肛周脓肿并接受了回肠造口重建术。他35岁时转诊至我科，因为尽管对复杂的会阴瘘反复进行挂线引流，其症状仍未改善。我们诊断为PRC合并盆腔脓肿和复杂的储袋瘘，并进行了挽救性手术。该诊断后来修订为克罗恩病。
一名50岁男性在18岁时被诊断为UC，并接受了高剂量类固醇治疗；然而，他的症状并未改善。他在另一家医院接受了全直肠系膜切除术、IPAA和回肠造口术。回肠造口关闭后，他的病情随后稳定下来。35岁时，他出现肛周疼痛，被诊断为复杂的储袋-会阴瘘。在储袋头侧回肠末端吻合钉线附近观察到一个瘘管。进行了回肠造口重建和挂线引流；然而，他的症状并未改善，于是转诊至我院。我们诊断为PRC合并盆腔脓肿和复杂的储袋瘘，并进行了挽救性手术。切除的标本在两个部位显示狭窄：输入袢开口处（在储袋处）和IPAA处。两名患者均重返社会，目前为门诊患者。
我们遇到两例IPAA术后PRC患者，挂线引流或回肠造口术均未能改善病情。在考虑患者生活质量和重新融入社会后，进行了储袋切除术。
