Abdominal Pain in a Patient With Diverted Bowel and Inflammatory Bowel Disease

Patients with medically refractory inflammatory bowel disease may undergo total proctocolectomy with ileal pouch-anal anastomosis. However, fecal diversion is necessary in patients with pouch failure. We present a rare case of pyogenic liver abscess (PLA) in a patient with ulcerative colitis with a history of ileal pouch-anal anastomosis complicated by chronic pouchitis requiring fecal diversion via loop ileostomy. The PLA was managed with computed tomography-guided aspiration drainage and antibiotics, followed by permanent ileostomy and pouch excision to prevent recurrence of PLA. This is the first case report of PLA in a patient with ulcerative colitis with a long-standing history of diversion pouchitis.