2016 Volume 69 Issue 2 Pages 108-114
A 67-year-old man was admitted with bloody stool lasting for six months. He was diagnosed as severe ulcerative pancolitis. Despite mesalazine, prednisolone treatment and leucocytapheresis, the clinical condition showed no improvement. Therefore, laparoscopy-assisted subtotal proctocolectomy was carried out. In the specimen, ulcerating lesions with neutrophil mucosal infiltration were spread over the entire colon and rectum, which extended to the terminal ileum beyond the ileocecal valve. On the second day after surgery, massive hemorrhage appeared from the ileal stoma.
Endoscopic examination from the ileal stoma revealed mucosal erosions and ulcers with oozing within 25cm of the ileum in a continuous fashion from the edge of the stoma. We had to resect the ileum between the site of 30cm proximal from the stoma and the stoma, and create a new ileostomy stoma. In general, though the inflammatory area of ulcerative colitis is limited to the colon, the ileum occasionally is involved by superficial inflammation (backwash ileitis), which extends proximally beyond the ileocecal valve. In emergency cases, it is hard to determine the extent of the disease preoperatively. We report a case of ulcerative colitis needing ileectomy due to massive hemorrhage associated with backwash ileitis after subtotal proctocolectomy.
