Successful endoscopic treatment of stapled J-pouch ileoanal canal anastomotic hemorrhage by argon plasma coagulation: a case report.
BACKGROUND
Continuous lower gastrointestinal hemorrhage is a rare condition, but it often requires proper management. We report a case of a patient with gastrointestinal hemorrhage 18 years after stapled J-pouch ileoanal canal anastomosis who was successfully treated with argon plasma coagulation.


METHODS
Our patient was a 54-year-old Japanese man who had developed ulcerative colitis 28 years ago. A J-shaped ileal pouch-anal anastomosis with a double-staple technique was indicated 18 years ago when the patient became refractory to the conventional medication. When he presented to our hospital, 18 years after the operation, the patient complained of faintness and fresh blood in the stool of 2 days' duration, and was admitted for investigation. Lower endoscopy revealed that the hemorrhage was from a neovascularization area close to the site of ileal pouch-anal anastomosis. Cap-assisted argon plasma coagulation was carried out for hemostasis, and complete hemostasis was achieved without complications.


CONCLUSIONS
We present a case of a patient with hemorrhage following a J-shaped ileal pouch-anal anastomosis with a double-staple technique performed 18 years ago. Argon plasma coagulation treatment was successful, suggesting the potential safety and effectiveness of colonoscopic electrocoagulation for controlling unremitting hemorrhage from a neovascularization area around a stapled ileoanal canal anastomotic site.
Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. takn-tky@umin.ac.jp.
Takeshi
T
Nishikawa
Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Keisuke
K
Hata
Department of Gastroenterology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Shuntaro
S
Yoshida
Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Koji
K
Murono
Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Koji
K
Yasuda
Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Kensuke
K
Otani
Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Toshiaki
T
Tanaka
Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Tomomichi
T
Kiyomatsu
Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Kazushige
K
Kawai
Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Hiroaki
H
Nozawa
Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Soichiro
S
Ishihara
Department of Gastroenterology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Kazuhiko
K
Koike
Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Toshiaki
T
Watanabe
D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D057908:Argon Plasma Coagulation / Q000379:methods*; D039021:Colonic Pouches; D004724:Endoscopy; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged
Argon plasma coagulation; Case report; Stapled anastomosis; Ulcerative colitis