Obstructed defecation after undiverted ileoanal pouch reconstruction for ulcerative colitis: Pharmacologic approach - Report of a case

PURPOSE: Obstructed defecation after ileal pouch construction has been repo rted only after closure of the diverting loop ileostomy, and biofeedback wa s an effective treatment modality. METHOD: This is a case report of a patie nt with immediate obstructed defecation after ileal pouch-anal anastomosis without a covering loop ileostomy and its successful pharmacologic manageme nt. RESULTS: A 38-year-old female underwent restorative proctectomy and sta pled ileal J-pouch-anal anastomosis without a covering loop ileostomy. On t he seventh postoperative day, her pouch catheter tin lieu of a covering loo p ileostomy) was removed and she failed to evacuate. After ruling out any t echnical complications, diltiazem was commenced with successful spontaneous pouch emptying. Obstructed defecation reoccurred after cessation of diltia zem one week later, but the symptoms resolved once the diltiazem was recomm enced. CONCLUSIONS: Obstructed defecation has been reported in patients aft er pelvic pouch reconstruction. However, in all those patients a diverting loop ileostomy had been raised and their obstructive symptoms were only app arent after closure of the ileostomy and when the pouch had healed. The con cern regarding our patient was the complete outlet obstruction so soon afte r surgery, with undue strain on the anastomosis and the potential risk of d isruption. Our only two options were either to create a diverting loop ileo stomy or to try a fast-acting pharmacologic agent (diltiazem) to treat the presumed levator spasm. The latter option spared the patient a further oper ation.