Hydronephrosis: Unrecognized complication following restorative proctocolectomy with ileal pouch-anal anastomosis

Restorative proctocolectomy with ileal pouch-anal anastamosis (IPAA) is the operation of choice to avoid permanent ileostomy in the surgical managemen t of patients with ulcerative colitis and familial adenomatous polyposis co li. IPAA with two loops of small intestine (J-pouch) is the most common con figuration. Mortality rates are low, and despite significant morbidity pati ent satisfaction remains high. Functional results are good in most cases. W e present two cases of hydronephrosis following IPAA. Loin pain was the pre senting symptom in both cases, with one patient developing impaired renal f unction. Hydronephrosis has not been reported following IPAA but with other forms of pelvic and retroperitoneal surgery it is believed to remain large ly asymptomatic We discuss the etiology of this preciously unrecognized com plication and suggest that it may be more prevalent following IPAA than is realized.