Endoscopy-assisted Transanal Division of an Apical Pouch Bridge after Restorative Proctocolectomy with a J-shaped Heal Pouch

摘要

There are several reports of so-called apical pouch bridge syndrome due to outlet obstruction of the J-shaped ileal pouch by an apical bridge. Division of this septum can resolve the outlet obstruction. We describe a successful en-doscopic procedure for division of an apical pouch bridge. An Endo-GIA stapler was then introduced into the ileal pouch alongside the endoscope, and division of the apical bridge required a few firings of the Endo-GIA stapler under transanal endoscopic guidance. The symptoms related to the apical pouch bridge were completely resolved without creation of an ileostomy.