Neoplasia of the pouch after IPAA

INTRODUCTION: Τotal colectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for refractory ulcerative colitis and inflammation of the pouch (pouchitis) is considered to be the most common complication. Neoplasia in the ileal pouch is reported to be a rather unusual entity.

ΑΙΜ: We present two patients with IPAA due to refractory ulcerative colitis who developed advanced neoplasia in the ileal pouch.

METHOD: Both patients reported increased bowel frequency suggestive of pouchitis, in combination with weight loss. The first patient developed adenocarcinoma in the afferent loop of the pouch fifteen years postoperatively. He underwent tumor excision followed by pouch reconstruction and adjuvant chemotherapy. Due to poor functionality of the pouch he had an additional operation with loop ileostomy and he is free of disease five years postoperatively. The second patient was diagnosed with stenosis of the ileo-anal anastomosis and adenocarcinoma of the pouch twenty years after IPAA. Due to serious malnutrition, a temporary loop ileostomy was created. The patient was being treated with neoadjuvant chemotherapy pending the pouch removal, which never occurred due to development of distal metastases [1] [2] [3].

CONCLUSION: Regardless the low probability of neoplasia development in the ileal pouch post-IPAA, it must always be considered in the differential diagnosis especially in patients with refractory pouchitis. Since patients with IPAA have a prolonged survival, therefore they should be endoscopically surveillanced according to formal guidelines.

Publication History

Article published online:
27 March 2025

• References

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