潰瘍性大腸炎に対し大腸全摘・J 型回腸囊肛門吻合術後にileal cast を生じた1 例

A 47-year-old man underwent ileal pouch anal anastomosis (IPAA) to treat ulcerative colitis (UC). Following the procedure, purulent mucous discharge from the anus was noted, though the condition improved with application of tazobactam/piperacillin and he was discharged. Thereafter, the patient discovered mucosal membrane tissue escaping through the stapled area from the anus and he returned for an examination. Endoscopy findings showed that the mucosa passed through the ileal J-pouch and a narrow opening located 5 cm from the site of anastomosis, which led us to determine that this was a case of ileal cast. The patient showed complications of pulmonary embolism and diabetes, discovered prior to the operation, while ischemia may also have been present. An ileal cast is rare and to the best of our knowledge this is the first report of such a case in Japan.