We report a patient with severe ulcerative colitis who underwent repeated ileal pouch-anal anastomosis with a new ileal J-pouch due to intractable perianastomotic abscess after initial ileal pouch-anal anastomosis. A 32-year-old man, who underwent staged restorative proctocolectomy for severe ulcerative colitis, suffered perianastomotic cuff abscess, pointed out in pouchography before ileostomy closure. Septic complications did not improve, despite three attempts at transanal repair, including curettage, unroofing, partial muscular cuff resection, and reanastomosis. The ileal J-pouch anal anastomosis was finally excised and a new ileal J-pouch-anal anastomosis was constructed from an abdominoperineal approach. The postoperative course after stoma closure was good and the patient experienced satisfactory anal function except for nocturnal soiling.
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