Global Journal of Digestive Diseases

Surgical Management of Total Proctocolectomy with Ileal J-Pouch Anal Reconstruction for Severe Ulcerative Colitis: Rare Case Report

Introduction: Ulcerative colitis is a chronic, relapsing, and potentially progressive form of Inflammatory Bowel Disease (IBD) characterized by inflammation localized to the mucosa of the rectum and colon. The etiology of ulcerative colitis is uncertain, several of etiological factors such as genetic predisposition, disturbances in the gut microbiome, immune dysregulation and environmental triggers have been implicated. There has been an evolution in the treatment of ulcerative colitis since the 1950's. From conventional management it evolved to the use of broadspectrum anti-inflammatory drugs such as amino-salicylates and corticosteroids, or immunomodulators, such as thiopurines, often sequentially. This therapy aims to relieve symptoms and achieve remission to prevent long-term complications. Case presentation: A 69-years old woman complained of continuous diarrhea for 2 months. Complaints accompanied by malaise, nausea, mild fever and weight loss of 5 kg. The abdominal examination was performed, there was pain over the entire surface of the stomach which was not typical, there was no distension, bowel sounds were within normal limits, and percussion pads were found tympanic sound. The patient had a history of a colonoscopy and biopsy performed in March 2024. The patient was decided to receive Total proctocolectomy surgical therapy with ileal Jpouch anal reconstruction and ileostomy. Discussion: Ileal-Pouch-Anal Anastomosis (IPAA) is a standard therapeutic procedure that is part of total proctocolectomy for ulcerative colitis patients. A systematic review study showed that the risk of high-grade dysplasia was quite low at 0.15% after restorative proctocolectomy and the frequency was similar in the pouch, anal transition zone and rectal cuff. With the use of stapled anastomosis, the length of the rectal cuff is one of the main determinants of quality of life after surgery. In this case the patient was diagnosed with severe ulcerative colitis. The diagnosis is made through history taking, physical examination, laboratory examination and colonoscopy with biopsy. Total proctocolectomy surgical therapy with ileal J-pouch anal reconstruction and ileostomy was perform, even though that procedure had complications such as abscesses, sepsis, fistulas and impaired fertility and sexual function postsurgery. The procedure was still carried out considering the severity of the disease. Conclusion: We recommend total proctocolectomy with ileal J-pouch anal reconstruction as an alternative procedure that is safe, feasible, effective, and has a relatively low postoperative complication rate for patients with severe ulcerative colitis.

Author(s): Joko Wibowo Sentoso* and Suryo Wahyu Raharjo

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