Clin Colon Rectal Surg 2010; 23(4): 259-268
DOI: 10.1055/s-0030-1268252
© Thieme Medical Publishers

Diagnosis and Management of Postoperative Ileal Pouch Disorders

Bo Shen1
  • 1Department of Gastroenterology/Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
Further Information

Publication History

Publication Date:
07 December 2010 (online)

ABSTRACT

Although restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the surgical treatment of choice for patients with refractory ulcerative colitis (UC) or UC with dysplasia, surgical, inflammatory, and noninflammatory adverse sequelae are common. Pouchitis, representing a spectrum of disease phenotypes, is the most common long-term complication of IPAA. De novo Crohn disease (CD) of the pouch can occur in patients with a preoperative diagnosis of UC. Differential diagnosis between fibrostenotic or fistulizing CD and surgery-associated strictures, sinuses, and fistulas often requires a combined assessment of symptom, endoscopy, histology, radiography, and examination under anesthesia. There is a role for endoscopic therapy for stricturing complications of IPAA. Chronic antibiotic-refractory pouchitis, refractory cuffitis, as well as fibrostenotic or fistulizing CD of the pouch are the leading late-onset causes for pouch failure.

REFERENCES

Bo Shen, M.D. 

Digestive Disease Institute, Desk A31

Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195

Email: [email protected]