Surgery>>>>>Colon, Rectum, and Anus
Question 14#

A 50-year-old woman who underwent a total colectomy with ileal pouch-anal reconstruction 5 years ago presents to the emergency room with diarrhea, fever, 2 weeks of malaise, and severe abdominal pain. What is the most appropriate differential diagnosis?

A. Parasitic infection, ulcerative colitis of the remaining rectal cuff, undiagnosed Crohn disease
B. Bacterial or viral infection, undiagnosed Crohn disease, and pouchitis
C. Rectal cancer of remaining rectal cuff, bacterial or viral infection, and undiagnosed Crohn disease
D. Parasitic infection, bacterial or viral infection, and pouchitis

Correct Answer is B

Comment:

This patient is likely presenting with pouchitis. Pouchitis is an inflammatory condition that affects both ileoanal pouches and continent ileostomy reservoirs. The incidence of pouchitis ranges from 30 to 55%. Symptoms include increased diarrhea, hematochezia, abdominal pain, fever, and malaise. Diagnosis is made endoscopically with biopsies. Differential diagnosis includes infection and undiagnosed Crohn disease.