title: Obstructed defecation after undiverted ileoanal pouch reconstruction for ulcerative colitis: pharmacologic approach. Report of a case.
abstract: OBJECTIVE
  Obstructed defecation after ileal pouch construction has been reported only after closure of the diverting loop ileostomy, and biofeedback was an effective treatment modality.
  
  
  METHODS
  This is a case report of a patient with immediate obstructed defecation after ileal pouch-anal anastomosis without a covering loop ileostomy and its successful pharmacologic management.
  
  
  RESULTS
  A 38-year-old female underwent restorative proctectomy and stapled ileal J-pouch-anal anastomosis without a covering loop ileostomy. On the seventh postoperative day, her pouch catheter (in lieu of a covering loop ileostomy) was removed and she failed to evacuate. After ruling out any technical complications, diltiazem was commenced with successful spontaneous pouch emptying. Obstructed defecation reoccurred after cessation of diltiazem one week later, but the symptoms resolved once the diltiazem was recommenced.
  
  
  CONCLUSIONS
  Obstructed defecation has been reported in patients after pelvic pouch reconstruction. However, in all those patients a diverting loop ileostomy had been raised and their obstructive symptoms were only apparent after closure of the ileostomy and when the pouch had healed. The concern regarding our patient was the complete outlet obstruction so soon after surgery, with undue strain on the anastomosis and the potential risk of disruption. Our only two options were either to create a diverting loop ileostomy or to try a fast-acting pharmacologic agent (diltiazem) to treat the presumed levator spasm. The latter option spared the patient a further operation.
authors.affiliation: Department of Surgery, Royal Gwent Hospital, Newport, United Kingdom.
authors.forename: F
authors.initials: F
authors.lastname: Abbasakoor
authors.forename: A
authors.initials: A
authors.lastname: Evans
authors.forename: B M
authors.initials: BM
authors.lastname: Stephenson
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001003:Anal Canal / Q000187:drug effects / Q000503:physiopathology; D003093:Colitis, Ulcerative / Q000601:surgery*; D003248:Constipation / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D003672:Defecation / Q000187:drug effects* / Q000502:physiology; D004110:Diltiazem / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D009119:Muscle Contraction / Q000187:drug effects; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D004110:Diltiazem