Pre-pouch ileitis after colectomy in paediatric ulcerative colitis

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http://www.blackwell-synergy.com/doi/abs/10.1111/j.1651-2227.2007.00632.x

To cite this article: Slatter, Safwat Girgis, Hien Huynh, Wael El-Matary Pre-pouch ileitis after colectomy in paediatric ulcerative colitis Acta Paediatrica (OnlineEarly Articles). doi:10.1111/j.1651-2227.2007.00632.x

CLINICAL OBSERVATION

Pre-pouch ileitis after colectomy in paediatric ulcerative colitis

Slatter11.Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stollery Children's Hospital, Edmonton, Canada, Safwat Girgis22.Department of Pathology, University Hospital, University of Alberta, Edmonton, Canada, Hien Huynh11.Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stollery Children's Hospital, Edmonton, Canada, Wael El-Matary11.Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stollery Children's Hospital, Edmonton, Canada

1.Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stollery Children's Hospital, Edmonton, Canada 2.Department of Pathology, University Hospital, University of Alberta, Edmonton, Canada

CorrespondenceDr. Wael El-Matary MD, MRCP, MRCPCH (UK), Assistant Professor of Pediatrics, Staff Physician, Division of Pediatric Gastroenterology, Faculty of Medicine, University of Alberta, Edmonton, Canada. Tel: +7804073339 | Fax: +7804073507 | Email: WaelElMatary@..., elmatary@...

Abstract

Colectomy and ileal pouch anal anastomosis (IPAA) is a potentially curative option for patients with ulcerative colitis (UC). A rare, postoperative complication is terminal ileitis which has been poorly documented in paediatric patients. A search of our paediatric inflammatory bowel disease (IBD) database revealed two boys with UC who were resistant to medical therapy. They each underwent colectomy with IPAA. One year later, both children represented with bloody diarrhoea and weight loss. Several endoscopies and biopsies showed acute on chronic mucosal inflammation in the pouch and up to 50 cm into the terminal ileum (TI). Biopsies revealed mixed inflammatory infiltrate with no granulomas.

Conclusion: Development of terminal ileitis after colectomy and IPAA can occur in children with UC. Although every effort should be made to exclude Crohn's disease as a cause of the terminal ileitis, this poorly defined condition should not be considered to be against the diagnosis of UC. More research is needed to develop a better understanding of the aetiopathogenesis of this uncommon condition.