Publication:

Small break, big threat: a rare case presentation of J-pouch ileal perforation

The ileal J pouch anal anastomosis (IPAA) is a common surgical option for patients undergoing restorative proctocolectomy for ulcerative colitis (UC). Perforation of the J pouch reservoir is a rare but serious complication. It can present with acute peritonitis and needs urgent surgical treatment. We report the case of a 30-year-old male with a history of UC who had previously undergone subtotal colectomy with IPAA along with diversion ileostomy and later ileostomy reversal. He came to the emergency department with sudden abdominal pain. On examination, he had generalised peritonitis and imaging showed pneumoperitoneum. An emergency exploratory laparotomy was performed. It showed a 1×1 cm perforation at the blind end of the J pouch loop along with one litre of toxic peritoneal fluid. Thorough peritoneal lavage done. The perforation was closed primarily and a proximal loop ileostomy was created. The patient recovered well after surgery and was discharged on postoperative day 12. This case shows the importance of early diagnosis and prompt surgical management of J pouch perforation in patients with a history of IPAA.