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Clin Colon Rectal Surg
DOI: 10.1055/s-0044-1786384
Review Article

Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies

Alex L. Huang
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
,
Marnie Abeshouse
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
,
Katherine C. Lee
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
,
Emily Rinebold
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
,
Maia Kayal
2   Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
,
Michael C. Plietz
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
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Abstract

De novo Crohn's disease (CD) of the pouch or Crohn's-like Ileal Pouch Illness (CLIPI) is an increasingly common occurrence in an ever-growing ileal pouch population. Although currently undetermined if a subset of classic CD or a completely new entity, it primarily affects the prepouch afferent limb, pouch, and rectal cuff. Symptoms can mimic other more common disorders, such as pouchitis, and requires a thorough workup, including pouchoscopy with biopsy and often cross-sectional imaging, for the diagnosis to be made. There is an increased risk of long-term pouch failure in this population. Treatment is typically dependent upon the disease phenotype with surgical management considered in a step-up fashion. Medical management is primarily performed with “biologics,” such as antitumor necrosis factor agents, although data are limited due to the lack of randomized controlled trials. Surgical management for CLIPI can include endoscopic, anorectal, and abdominal approaches to assist as “pouch-salvage strategies.” The performance of advanced pouch-salvage techniques in the CLIPI population requires careful patient selection and should preferably be performed at high-volume pouch centers.

Keywords

de novo Crohn's disease - Crohn's-like ileal pouch illness - Crohn's disease of the pouch - Crohn's disease-like pouch inflammation


Publication History

Article published online:
10 May 2024

© 2024. Thieme. All rights reserved.

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