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A 39 year old woman with a stapled J pouch following proctocolectomy for ulcerative colitis in 1998 presented with abdominal pain and diarrhoea during her pregnancy in 2003. She continued to be symptomatic with incomplete pouch evacuation and pelvic discomfort following her caesarean delivery. An abdominal radiograph (fig 1) showed a calcified smooth mass in the pelvis. Endoscopy confirmed a mass adherent to the proximal end of her pouch. She underwent a rectal examination under anaesthesia but the mass was not amenable to removal by the transanal route. She later underwent a laparotomy at which the pouch was found to be capacious and the ileum just proximal to the pouch being dilated. The pouch was opened at its proximal end and the mass delivered from the pouch. The patient made an uneventful recovery. Figure 2 shows the complete and cross sectional views of the mass.
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