Surgery, Gastroenterology and Oncology

A restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has been considered a gold standard surgical procedure for patients with ulcerative colitis (UC). Even if patients with UC underwent high quality IPAA after proctocolectomy, pouch related complications occurred in over 50% of them more than five years after surgery.
The most common pouch related complication is pouchitis including frequent bowel movements, urgency, cramping and bloody stools. We experienced unusual postoperative pouch related complication, pouch inertia, in two female patients over ten years after IPAA. Pouch inertia is the state that pouch is expanded due to losing shrinkage ability.
It is considered one of pouch failure however it remains unknown. The patient who underwent pouch resection has been fine after the surgery, but the other patient who did not undergo pouch resection by her decision-making died. Because a pouch inertia is a frequent cause of life-threatening disease, pouch resection should be performed for patients with pouch inertia as soon as possible.
We report unusual postoperative pouch related complication in two ulcerative colitis cases.

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