title: Pouchitis and pre-pouch ileitis developed after restorative proctocolectomy for ulcerative colitis: a case report.
abstract: We report a case of pouchitis and pre-pouch ileitis, and inflammation in the neo-terminal ileum proximal to the pouch, developed after restorative proctocolectomy for ulcerative colitis. A 35-year old female presented with fever and abdominal pain five weeks after ileostomy closure following proctocolectomy. Computed tomography showed collection of feces in the pouch and proximal ileum. A drainage tube was placed in the pouch perianally, and purulent feces were discharged. With antibiotic treatment, her symptoms disappeared, but two weeks later, she repeatedly developed fever and abdominal pain along with anal bleeding. Pouchscopy showed mucosal inflammation in both the pouch and the pre-pouch ileum. The mucosal cytokine production was elevated in the pouch and pre-pouch ileum. With antibiotic and corticosteroid therapy, her symptoms were improved along with improvement of endoscopic inflammation and decrease of mucosal cytokine production. The fecal stasis with bacterial overgrowth is the major pathogenesis of pouchitis and pre-pouch ileitis in our case.
authors.affiliation: Inflammatory Bowel Disease Center and Department of Surgery, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie 510-0016, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwata
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Umegae
authors.forename: Koichi
authors.initials: K
authors.lastname: Matsumoto
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D007079:Ileitis / Q000209:etiology*; D019449:Pouchitis / Q000209:etiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*