Question: A 49-year-old female with a history of ulcerative colitis diagnosed at age 30 underwent ileal pouch anal anastomosis (IPAA) 17 years ago for medically refractory disease. She presented to the clinic for evaluation of chronic diarrhea, intermittent lower abdominal pain, and recurrent small-bowel obstructions. Her diarrhea had been present since her initial pouch formation, whereas the abdominal pain and recurrent bowel obstructions had escalated in recent years. Although she described frequent small-volume liquid stools, she also endorsed intermittent constipation requiring significant straining.
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