This report presents the case of a 54-year-old man who had undergone restorative proctocolectomy with ileal pouch-anal anastomosis 15 years previously because of acute severe ulcerative colitis. After the operation, he experienced recalcitrant pouchitis and recurrent ulcer bleeding. There was a marked improvement in his symptoms following the administration of twice-daily budesonide 2mg foam injection for two months. Budesonide foam is suggested as a new therapy for pouchitis.