潰瘍性大腸炎術後30 年目にJ 型回腸囊内にhigh grade dysplasia を認めた1 例

We treated a 63-year-old man with ulcerative colitis at the age of 32 years. At 33 years old, the condition was intractable, thus a total colectomy and ileal pouch-anal anastomosis were performed. At 25 years after surgery, diarrhea, bloody bowel discharge, and anal regional pain were noted. Results of examinations at that time led to a diagnosis of ileal pouchitis and antibiotic administration was given for symptom exacerbation for the first time after the operation at the age of 58 years. When the patient was 63 years old, anal region pain returned, and a close inspection showed exacerbation of ileal pouchitis and anastomic fistula formation. The ileal pouchitis improved with intravenous antibiotic, while low grade dysplasia from an upheaval-related lesion in the ileal pouch was shown by endoscopy and biopsy findings. Ileal pouchitis was diagnosed based on a biopsy specimen obtained from the lower part of the gastrointestinal tract during an endoscopic examination. However, 6 months later the patient was affected by high grade dysplasia. Construction of an ileal artificial anus was performed for the fistula in the anal region which was complicated pouch resection. This was an extremely rare case of merged high grade dysplasia, for which a Jpouch was employed 30 years after diagnosis of ulcerative colitis.