今回我々は遅発性膿瘍およびaoical bridge,blind loopによる回腸嚢の形態的問題が原因と考えられた2次性回腸嚢炎に対してsalvage operationを施行し,良好に経過をした1例を経験したので報告する.患者は20歳の女性.潰悟性大腸炎2期分割手術の1期目手術後約3か月目に突然の粘血便を認めた.回腸嚢の形態的問題およびperipouch abscessに起因する2次性回腸嚢炎と判断し,残存直腸切除,回腸嚢部分切除,回腸嚢再建,回腸嚢肛門吻合,回腸人工肛門造設術を施行した.術後回腸嚢の炎症は軽快し,肛門機能低下も認めない.現在は回腸人工肛門閉鎖術を終了し,外来で経過観察中であるが回腸嚢炎は認めない.
Secondary pouchitis is defined as a mucosal inflammatory lesion in the ileal reservoir, that is provoked by pouch-related complications following a total colectomy and ileal pouch anal anastomosis. We report a case of secondary pouchitis that was successfully treated by salvage surgery. A 20-year-old woman with ulcerative colitis developed an acute, severe bloody diarrhea following a proctocolectomy, ileal pouch anal-canal anastomosis and diverting ileostomy. She was diagnosed as having secondary pouchitis arising from a peripouch abscess, apical bridge or blind loop formation. The remnant rectum and ileal pouch were excised, and a new ileal pouch-anal anastomosis and diverting ileostomy were made. The patient's postoperative course was uneventful, and she has shown no further signs of pouchitis. Salvage surgery may be a valuable treatment for treating secondary pouchitis when the pouchitis is caused by surgery-related complications.
潰瘍性大腸炎術後,回腸嚢炎に対してsalvage operationを施行した1例
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