Two-time perforation of the ileal J-pouch 6 and 18 years after restorative proctocolectomy and ileal pouch–anal anastomosis for familial adenomatous polyposis: a case report

Surgical Case Reports

Sodai Sakamoto¹  Akinobu Taketomi¹  Asami Suzuki²  Yasunobu Terasaki³  Shota Ebinuma³  Kengo Shibata⁴ 

[1] Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Hokkaido, Japan;Division of Nursing, Wakkanai City Hospital, 03-13-15, Chuo, 097-8686, Wakkanai City, Hokkaido, Japan;Division of Surgery, Wakkanai City Hospital, 03-13-15, Chuo, 097-8686, Wakkanai City, Hokkaido, Japan;Division of Surgery, Wakkanai City Hospital, 03-13-15, Chuo, 097-8686, Wakkanai City, Hokkaido, Japan;Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Hokkaido, Japan;

关键词: Familial adenomatous polyposis;    Ileal pouch–anal anastomosis;    Restorative proctocolectomy;    Perforation;   

DOI  :  10.1186/s40792-021-01355-9

来源: Springer

【 摘 要 】

BackgroundPerforation of the ileal J-pouch after restorative proctocolectomy and ileal pouch–anal anastomosis are extremely rare. There has been no report of perforation of the ileal J-pouch occurring twice over several years. We report the first case of perforation at 6 and 18 years following restorative proctocolectomy.Case presentationThe patient was a 52-year-old man who underwent a two-stage restorative proctocolectomy with a hand-sewn ileal J-pouch anal anastomosis due to familial adenomatous polyposis and sigmoid colon cancer at 34 years of age. At the age of 40, he underwent ileal pouch resection at its blind end, abdominal drainage, and anastomotic dilatation. The patient had a perforation of the blind end of the ileal J-pouch from increased intraluminal pressure, with anastomotic stricture and pervasive peritonitis. The patient had no symptoms for a few years; however, 18 years after the initial surgery and 12 years after the first perforation, the patient presented with severe abdominal pain. Computed tomography demonstrated pneumoperitoneum; accordingly, laparotomy was performed. Upon opening the abdominal cavity, contaminated ascites and inflammatory changes were documented involving the ileum. A 2-mm perforation involving the blind end of the ileal J-pouch was also observed and repaired, followed by temporary loop ileostomy creation. Postoperative endoscopy revealed an ulcer in the ileal J-pouch and a stricture located directly at the anastomosis.ConclusionsThe blind end of the J-pouch repeatedly perforated over the years due to recurrent anastomotic stricture. Regular surveillance is, therefore, considered necessary for the release of stricture, maintenance of anastomotic patency, and prevention of ileal J-pouch perforation.

【 授权许可】

CC BY