title: Image-guided sharp recanalization of a benign J pouch anastomotic occlusion facilitates surgical repair.
abstract: A 27-year-old man with a 9-year history of ulcerative colitis who had undergone total proctocolectomy with construction of a continent pouch in 2008 presented 1 year later with occlusion of the ileal pouch-anal anastomosis precluding ileostomy closure. An attempt at surgical reconstruction at an outside hospital failed, and the patient was informed that he would have a permanent stoma. A further attempt at blind surgical recanalization of the occlusion risked sphincter damage and was deferred. In 2010, reconstruction was performed using a hybrid approach combining image-guided sharp recanalization of the occluded anastomosis with positioning of a large-diameter Foley balloon catheter across the recanalized segment, followed by immediate surgical revision of the J pouch. Ileostomy closure was performed 1 month later. Continence was preserved. Surgical repair preceded by sharp recanalization with positioning of a balloon catheter across the occluding membrane may safely regain durable patency in a chronically occluded ileal pouch-anal anastomosis.
authors.affiliation: Department of Radiology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel 91120.
authors.forename: Samuel
authors.initials: S
authors.lastname: Mahgerefteh
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel 91120.
authors.forename: Alon
authors.initials: A
authors.lastname: Pikarsky
authors.affiliation: Department of Radiology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel 91120. Electronic address: allan@hadassah.org.il.
authors.forename: Allan I
authors.initials: AI
authors.lastname: Bloom
mesh_terms: D000328:Adult; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D003251:Constriction, Pathologic; D004106:Dilatation / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D015641:Radiography, Interventional; D012086:Reoperation; D016896:Treatment Outcome; D062666:Vascular Access Devices