Sequential Biologic, Small-Molecule, and GLP-1 Analogue Therapy in Postcolectomy Enteritis With High Output Stoma.

Postcolectomy enteritis is a rare but serious complication after colectomy for ulcerative colitis. We report the case of a 71-year-old man with acute severe ulcerative colitis who developed steroid-refractory postcolectomy enteritis after subtotal colectomy with end ileostomy. Postoperatively, he experienced persistent high output stoma and ongoing ileal inflammation despite treatment with corticosteroids, infliximab, upadacitinib, and octreotide. Induction therapy with ustekinumab led to gradual endoscopic, histological, and radiological improvement. Off-label use of a glucagon-like peptide-1 analogue was initiated for the management of high output stoma, with subsequent reduction in stoma losses and successful weaning from parenteral nutrition.