Pre-pouch ileitis after colectomy in paediatric ulcerative colitis

Colectomy and ileal pouch anal anastomosis (IPAA) is a potentially curative option for patients with ulcerative colitis (UC). A rare, postoperative complication is terminal ileitis which has been poorly documented in paediatric patients. A search of our paediatric inflammatory bowel disease (IBD) database revealed two boys with UC who were resistant to medical therapy. They each underwent colectomy with IPAA. One year later, both children represented with bloody diarrhoea and weight loss. Several endoscopies and biopsies showed acute on chronic mucosal inflammation in the pouch and up to 50 cm into the terminal ileum (TI). Biopsies revealed mixed inflammatory infiltrate with no granulomas. Conclusion: Development of terminal ileitis after colectomy and IPAA can occur in children with UC. Although every effort should be made to exclude Crohn's disease as a cause of the terminal ileitis, this poorly defined condition should not be considered to be against the diagnosis of UC. More research is needed to develop a better understanding of the aetiopathogenesis of this uncommon condition.