Symptomatic Post-anastomotic Blind Ileal Pouch

Postsurgical blind pouch syndrome is an uncommon late complication of intestinal reconstruction caused by stasis within a poorly emptying bowel segment.Its manifestations range from chronic diarrhea and abdominal discomfort to bleeding, obstruction, inflammation, and perforation, while diagnosis may be difficult when the previous operative anatomy is unknown.We report the case of a 48-year-old man who presented with severe right-sided abdominal pain, distension, and peritoneal irritation three years after emergency bowel resection and an undocumented intestinal anastomosis following a motor vehicle collision.Since the previous operation, he had experienced frequent bowel movements and fecal urgency that substantially impaired his quality of life.Initial computed tomography and diagnostic laparoscopy failed to identify a definitive cause of his symptoms, and extensive adhesions prevented complete characterization of the reconstruction.Persistent severe pain, fever, and marked elevation of inflammatory markers prompted repeat exploration five days later.Laparotomy demonstrated a patent side-to-side ileocecal anastomosis associated with a markedly dilated and thickened blind ileal pouch and a separate atrophic terminal ileal remnant.The blind pouch was resected.Histopathological examination revealed superficial mucosal ulceration, muscular hypertrophy, edema, hemorrhage, focal liquefactive necrosis, and acute-on-chronic transmural inflammation without malignancy.Recovery was uneventful.At three-month follow-up, the patient remained asymptomatic and medication-free, with normal bowel function and complete resolution of fecal urgency and abdominal pain.This case highlights that a postsurgical blind ileal pouch may cause severe acute inflammation even without gross perforation and should be considered in patients with unexplained abdominal symptoms after intestinal reconstruction.