Mid Pouch Strictureplasty for Crohn's Disease After Ileal Pouch-Anal Anastomosis: An Alternative to Pouch Excision

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Abstract
A 33-year-old female developed an isolated stricture of the mid portion of her ileal pouch nine years after proctocolectomy and J-ileal pouch-anal anastomosis for ulcerative colitis. Repeated episodes of pouchitis and partial small-bowel obstruction led to pouchoscopy and pouchography, which demonstrated pouch inflammation and a long, tight, midpouch stricture. Her diagnosis was changed to Crohn's disease and she was treated with azathioprine, budesonide, and infliximab. Repeat pouchoscopy demonstrated mucosal healing but a persistent fibrotic stricture. Pouch reconstruction was performed with a midpouch strictureplasty alleviating her obstructive symptoms. One year after surgery, the patient has no clinical evidence of obstruction and repeat pouchography demonstrates a wider pouch lumen across the strictureplasty site. Strictureplasty is an alternative to pouch excision in the management of patients with Crohn's disease who have an isolated pouch stricture.

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