Small intestinal bleeding following total proctocolectomy and an ileal pouch-anal anastomosis for Ulcerative colitis

We report a case of bleeding of the small intestine following total colectomy for ulcerative colitis. A 39-year-old woman underwent total proctocolectomy, ileal pouch-anal anastomosis and loop ileostomy for refractory ulcerative colitis. The postoperative clinical course was uneventful, and she underwent closure of the ileostomy about 4 months after the primary operation. She developed postoperative bowel obstruction, and required therapy with long tube intercalation. Massive melena appears on postoperative day 39. She fell into pre-shock condition, so we performed an emergency laparotomy on postoperative day 41. On intraoperative transanal endoscopy, we found diffuse erosion and oozing in the small intestine but no active bleeding point was seen. Biopsy was performed from the area of erosion point of the small intestine. The pathology suggested that the mucosal inflammation was similar to ulcerative colitis, so we started intravenous administration of prednisolone. Angiography 6 days after the re-operation revealed extravasation from the peripheral region of the second jejuna artery was seen. We performed transcatheter arterial embolization. Thereafter, the melena disappeared, and she was discharged 27 days after the emergency laparotomy.