Redo Ileal pouch-anal anastomosis combined with anti-TNF-α maintenance therapy for Crohn's disease with pelvic fistula: report of two cases.
Pouch failure has been reported to occur after ileal pouch-anal anastomosis for Crohn's disease. We report two cases of patients with Crohn's disease, who underwent redo ileal pouch-anal anastomosis (redo-IPAA) combined with anti-TNF-α maintenance therapy, with good functional results. The first patient, a man with presumed ulcerative colitis, suffered pelvic fistula recurrence and anastomotic dehiscence. He underwent redo-IPAA, at which time longitudinal ulcers were found. Infliximab was started 4 days postoperatively and continued. The second patient, a woman treated for ulcerative colitis, underwent laparoscopic IPAA 8 years later. After the development of a pelvic fistula, twisted mesentery of the ileal pouch was found intraoperatively and Crohn's disease was diagnosed. Adalimumab therapy resulted in fistula closure. Redo-IPAA was performed to normalize the twisted mesentery of the ileal pouch. No complications have been observed in either patient, both of whom have experienced good functional results after closure of the covering stomas.
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan, taraki@clin.medic.mie-u.ac.jp.
Toshimitsu
T
Araki
Yoshiki
Y
Okita
Hiroyuki
H
Fujikawa
Masaki
M
Ohi
Koji
K
Tanaka
Yasuhiro
Y
Inoue
Keiichi
K
Uchida
Yasuhiko
Y
Mohri
Masato
M
Kusunoki
D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D039021:Colonic Pouches; D003424:Crohn Disease / Q000150:complications / Q000628:therapy*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005402:Fistula / Q000150:complications* / Q000628:therapy; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006801:Humans; D000069285:Infliximab; D060046:Maintenance Chemotherapy; D008297:Male; D010388:Pelvis; D012086:Reoperation; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab