Redo Ileal pouch-anal anastomosis combined with anti-TNF-α maintenance therapy for Crohn's disease with pelvic fistula: report of two cases.

Abstract

Pouch failure has been reported to occur after ileal pouch-anal anastomosis for Crohn's disease. We report two cases of patients with Crohn's disease, who underwent redo ileal pouch-anal anastomosis (redo-IPAA) combined with anti-TNF-α maintenance therapy, with good functional results. The first patient, a man with presumed ulcerative colitis, suffered pelvic fistula recurrence and anastomotic dehiscence. He underwent redo-IPAA, at which time longitudinal ulcers were found. Infliximab was started 4 days postoperatively and continued. The second patient, a woman treated for ulcerative colitis, underwent laparoscopic IPAA 8 years later. After the development of a pelvic fistula, twisted mesentery of the ileal pouch was found intraoperatively and Crohn's disease was diagnosed. Adalimumab therapy resulted in fistula closure. Redo-IPAA was performed to normalize the twisted mesentery of the ileal pouch. No complications have been observed in either patient, both of whom have experienced good functional results after closure of the covering stomas.

• Authors: Toshimitsu Araki, Yoshiki Okita, Hiroyuki Fujikawa, Masaki Ohi, Koji Tanaka, Yasuhiro Inoue, Keiichi Uchida, Yasuhiko Mohri, Masato Kusunoki
• Journal: Surgery today (Surg Today) Vol. 44 Issue 10 Pg. 1982-5 (Oct 2014) ISSN: 1436-2813 [Electronic] Japan
• PMID: 24442570 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Gastrointestinal Agents
• Tumor Necrosis Factor-alpha
• Infliximab

Topics

• Adult
• Anal Canal (surgery)
• Anastomosis, Surgical (methods)
• Antibodies, Monoclonal (administration & dosage)
• Colonic Pouches
• Crohn Disease (complications, therapy)
• Digestive System Surgical Procedures (methods)
• Female
• Fistula (complications, therapy)
• Gastrointestinal Agents (administration & dosage)
• Humans
• Infliximab
• Maintenance Chemotherapy
• Male
• Pelvis
• Reoperation
• Treatment Outcome
• Tumor Necrosis Factor-alpha (immunology)