A 63 year old man was diagnosed with Ulcerative Colitis 32 years ago at another hospital. He had a panproctocolectomy and ileo-anal pouch (“J" pouch) fashioned 22 years ago (at the same hospital; no records available). Over the past couple of years he has had crampy abdominal pain, tiredness and loose bowels (6x/day). Routine blood tests: Hb 13.8, ESR 25, CRP 7, Albumin 31. A small bowel MRI scan was normal. The attached video shows the pouchoscopy.
What do you think? Is this "just pouchitis?" Was the original diagnosis of UC correct? Or does he have Crohn’s disease?
Bo Shen, Victor W. Fazio, Feza H. Remzi and Bret A. Lashner,
Clinical Approach to Diseases of Ileal Pouch-Anal Anastomosis, Am J Gastroenterol 2005;100:2796–2807.