PMC6091410_01
Colonoscopy with intubation of terminal ileum shows diffusely erythematous and granular mucosa with focal exudation affecting the rectum through ascending colon, with sparing of the cecum and terminal ileum. The endoscopic findings are consistent with UC.
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Colonoscopy with terminal ileal intubation revealed severely erythematous and granular mucosa with focal exudation from rectum to ascending colon, findings consistent with UC (Figure 1), and revealed endoscopically normal appearing cecum and terminal ileum.
Photomicrograph of histopathology with H&E stain of biopsy specimen shows normal ileal mucosa prior to postoperative occurrence of prepouch ileitis, with relatively normal villous height and preserved villous-to-crypt ratio.
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The cecum and terminal ileum appeared histologically normal (Figure 2).
(a) Coronal section of computerized tomographic enterography shows focal mural thickening and enhancement of afferent limb of the J-pouch 1 year after undergoing IPAA and RPC for ulcerative colitis refractory to medical therapy. (b) Transverse section of computerized tomographic enterography shows mucosal hyperenhancement, mural thickening, and luminal narrowing of a 9.4 cm long segment of terminal ileum 1 year after undergoing IPAA and RPC for ulcerative colitis refractory to medical therapy.
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C-reactive protein (CRP) level was elevated. Computerized tomographic enterography (CTE) showed focal narrowing and enhancement of mucosa within the J-pouch and abnormal mucosal enhancement, mural thickening, and narrowing of afferent ileal limb (Figures 3(a) and 3(b)).
(a) Pouchoscopy shows ulceration and mild inflammation in the J-pouch. (b) Pouchoscopy shows ulceration and mild inflammation in the terminal ileum proximal to the J-pouch.
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Pouchoscopy showed moderate exudation and ulcerations in J-pouch (Figure 4(a)) and in afferent ileal limb up to 50 cm (Figure 4(b)).
Histopathology with H&E shows near total loss of villi, crypt architectural distortion, and crypt abscesses (arrows) in endoscopic biopsies obtained 20 cm from anal verge, findings highly consistent with prepouch ileitis after creation of a J-pouch.
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Histopathologic analysis of J-pouch and afferent ileal limb biopsies revealed chronic active inflammation, highly consistent with pouchitis and PI (Figure 5).