A Case of Refractory Pouchitis with Postoperative Anal Stenosis after Ileal Pouch-anal Anastomosis Treated with Vedolizumab, a Radial Incision and Cutting.

A 33-year-old man who had undergone total colectomy for refractory ulcerative colitis (UC) at 22 years of age was referred for severe pouchitis with anal stricture. The remission of pouchitis was achieved with vedolizumab (VDZ) treatment. However, as diarrhea improved, obstructive defecation symptoms became apparent due to the stricture. Repeated anal bougie dilation was unsuccessful. A radial incision and cutting were thus performed, and the defecation symptoms improved without recurrence for 1 year. This is the first case report demonstrating the effectiveness of a radial incision and cutting for the treatment of severe anal stenosis after ileal pouch-anal anastomosis, particularly in a short, fibrotic stricture site refractory to repeated bougie dilatation.