Post Colectomy Ileitis in patients with Ulcerative Colitis: A Diagnostic Challenge

Antakia R*, Toquero L, Lishman S and Makhija R

Aims: Post-colectomy ileitis is a common yet challenging disease entity. We present our management approach in these complex patients.

Methods: We present a case series of four patients with post-colectomy ileitis in patients with Ulcerative Colitis (UC).

Results: Despite optimal medical therapy, these patients underwent subtotal colectomy with end ileostomy and were discharged with tapering steroid regimen. They represented acutely (2-4 weeks) or chronically (months to years) with severe abdominal pain and/or problematic stoma output. Three patients required re-laparotomies, with two requiring further small bowel resection. Histology revealed necrosis and perforation but no granulomas. Diagnosis of post-colectomy ileitis was made. Both patients who underwent further bowel resection responded well to steroid therapy with Total Parenteral Nutrition (TPN) and remain on endoscopic surveillance. Symptomatic control was achieved with systematic/local steroid therapy in the remaining two patients.

Discussion/Conclusion: Steroid therapy with TPN is the mainstay of treatment in these patients to address nutritional needs especially those requiring multiple laparotomies.

Post-colectomy ileitis should be considered as a differential in UC patients post total colectomy with persistent abdominal symptoms and exclusion of other types of ileitis should be examined with histological and radiological investigations. Multi-disciplinary approach is mandatory and management of these patients in randomised clinical/controlled trial (RCT) setting is required.

What does this paper add to the existing literature

We present a case series of four patients with post-colectomy ileitis in patients with ulcerative colitis to highlight the existence of this condition. Despite optimum medical therapy, patients who underwent subtotal colectomy with end ileostomy, represented with severe abdominal symptoms. We adopted multidisciplinary approach including patient's preference and close follow-up in managing this challenging complex condition.

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Published on: Apr 21, 2020 Pages: 18-21

Full Text PDF Full Text HTML DOI: 10.17352/2455-2968.000089
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