Pouch-sacral fistula three years after restorative proctocolectomy for ulcerative colitis

Fistula formation after restorative proctocolectomy poses a challenge to th e surgeon and sometimes can lead to the excision of the pouch. A 21-year-ol d female patient developed an ileal J-pouch-sacral fistula with abscess and osteomyelitis of the sacrum, more than three years after the pouch constru ction for ulcerative colitis. Two months prior to this event, the patient h ad a single and transient episode of pouchitis. The role of pouchitis in th e aetiopathogenesis of the fistula is unclear. To our knowledge, the late d evelopment of such a fistula has not been reported previously.