scholarly journals Recurrent Volvulus of an Ileal Pouch Requiring Repeat Pouchopexy: A Lesson Learnt

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Pär Myrelid ◽  
Pelle Druvefors ◽  
Peter Andersson
Keyword(s):  
Ulcerative Colitis ◽  
Ileal Pouch ◽  
Late Complications ◽  
Pelvic Pouch ◽  
Reoperative Surgery ◽  
Single Row ◽  
Anal Anastomosis ◽  
Restorative Surgery ◽  
Presacral Fascia

Introduction. Restorative surgery for ulcerative colitis with ileal pouch anal anastomosis (IPAA) is frequently accompanied by complications. Volvulus of the ileal pouch is one of the most rarely reported late complications and to our knowledge no report exists on reoperative surgery for this condition.Case Report.A 58-year-old woman who previously had undergone restorative proctocolectomy due to ulcerative colitis with an IPAA presented with volvulus of the pouch. She was operated with a single row pouchopexy to the presacral fascia. Two months later she returned with a recurrent volvulus. At reoperation, the pouch was found to have become completely detached from the fascia. A new pexy was made by firmly anchoring the pouch with two rows of sutures to the presacral fascia as well as with sutures to the lateral pelvic walls. At follow-up after five months she was free of symptoms.Conclusion. This first report ever on reoperative surgery for volvulus of a pelvic pouch indicates that a single row pouchopexy might be insufficient for preventing retwisting. Several rows seem to be needed.

scholarly journals Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis

2003 ◽  
Vol 58 (4) ◽  
pp. 193-198 ◽  
Author(s):  
Magaly Gemio Teixeira ◽  
Adauto C. Abreu da Ponte ◽  
Manuela Sousa ◽  
Maristela G. de Almeida ◽  
Edésio Silva Filho ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Ileal Pouch ◽  
Severe Disease ◽  
Functional Results ◽  
Late Complications ◽  
Ileal Pouch Anal Anastomosis ◽  
Early Complications ◽  
Anal Anastomosis

Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS: Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS: The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5%). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8%) 1 year after ileal pouch-anal anastomosis, 9 (14.8%) after 3 years, 13 (21.3%) after 5 years, and 16 (26.2%) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later. CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up.

Elevated Platelet Count before Ileal Pouch–Anal Anastomosis for Ulcerative Colitis is Associated with the Development of Chronic Pouchitis

2005 ◽  
Vol 71 (10) ◽  
pp. 821-826 ◽  
Author(s):  
Aderet Okon ◽  
Marla Dubinsky ◽  
Eric A. Vasiliauskas ◽  
Konstantinos A. Papadakis ◽  
Andrew Ippoliti ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Platelet Count ◽  
Ileal Pouch ◽  
Ileal Pouch Anal Anastomosis ◽  
Management Problem ◽  
Reactive Thrombocytosis ◽  
Normal Platelet Count ◽  
Normal Platelet ◽  
Anal Anastomosis

Acute pouchitis (AP) after ileal pouch–anal anastomosis (IPAA) is common and easily treated. However, chronic pouchitis (CP) remains a difficult management problem and may represent a form of Crohn disease (CD) of the ileal pouch. Because CD patients have higher platelet counts than ulcerative colotis (UC) patients, we prospectively evaluated the association between preoperative platelet count and pouchitis development in 159 patients undergoing IPAA. Reactive thrombocytosis (RT) was defined as a platelet count >450 x 109/L. Median preoperative platelet count was 312 x 109/L (range, 103 x 109/L to 886 x 109/L). One hundred twenty-five patients (79%) had a normal (150 x 109/L to 450 x 109/L) platelet count (-RT patient group). Twenty-eight patients (18%) had RT. Six patients (3%) had a platelet count below 150 x 109/L. After a median follow-up of 13 months, 45 patients (28%) developed pouchitis. Pouchitis developed in 33 +RT patients (26%) versus 9 -RT patients (32%) ( P = NS). UC patients who had +RT had a 25 per cent incidence of CP compared to only 7 per cent of those UC patients who had -RT ( P = 0.03). The incidence of CP was significantly higher after IPAA in UC patients having thrombocytosis before surgery compared to UC patients having a normal platelet count before surgery.

De novo Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis and Inflammatory Bowel Disease Unclassified: Long-Term Follow-Up of a Prospective Inflammatory Bowel Disease Registry

2016 ◽  
Vol 82 (10) ◽  
pp. 977-981 ◽  
Author(s):  
Karen Zaghiyan ◽  
Jan P. Kaminski ◽  
Galinos Barmparas ◽  
Phillip Fleshner
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Ileal Pouch ◽  
De Novo ◽  
Anal Anastomosis ◽  
Long Term Follow Up ◽  
Inflammatory Bowel

The risk of de novo Crohn's disease (CD) after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) versus inflammatory bowel disease unclassified (IBDU) or indeterminate colitis (IC) remains debatable. Here, we present updated results after long-term follow-up of a previously studied cohort of 334 patients with UC, IBDU, or IC who underwent IPAA during a 10-year period ending 2007. Of 334 study patients, 56 per cent were male and median age was 38 years (range: 8–81). Patients were classified as UC (n = 237) or IBDU (n = 97) preoperatively and UC (n = 236) or IC (n = 98) postoperatively. After a median follow-up of 76 months (range: 3–236), 63 patients (19%) developed CD within a median of 22 months (range: 1–213) from ileostomy closure compared with the previously published 40 patients (12%) with 26-month follow-up ( P = 0.01). The development of de novo CD was similar for patients undergoing IPAA for UC (n = 40; 17%), IBDU (n = 21; 22%) or those classified as having UC (n = 42; 18%) or IC (n = 19; 19%) postoperatively; P > 0.05. Thus, patients with IBDU and IC can expect equivalent long-term outcome to patients with UC after IPAA. Pouch failure occurred in 13 (4%) study patients and was equal among all four groups.

scholarly journals Inflammatory Pouch Conditions Are Common After Ileal Pouch Anal Anastomosis in Ulcerative Colitis Patients

2019 ◽  
Vol 26 (7) ◽  
pp. 1079-1086 ◽  
Author(s):  
Maia Kayal ◽  
Michael Plietz ◽  
Anam Rizvi ◽  
Marlana Radcliffe ◽  
Alexa Riggs ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Ileal Pouch ◽  
Multivariable Analysis ◽  
Ileal Pouch Anal Anastomosis ◽  
Total Proctocolectomy ◽  
Refractory Disease ◽  
Pouch Failure ◽  
Increased Risk ◽  
Anal Anastomosis

Abstract Background Total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) is the gold standard surgery for ulcerative colitis (UC) patients with medically refractory disease. The aim of this study was to report the rates and risk factors of inflammatory pouch conditions. Methods This was a retrospective review of UC or IBD unspecified (IBDU) patients who underwent TPC with IPAA for refractory disease or dysplasia between 2008 and 2017. Pouchoscopy data were used to calculate rates of inflammatory pouch conditions. Factors associated with outcomes in univariable analysis were investigated in multivariable analysis. Results Of the 621 patients more than 18 years of age who underwent TPC with IPAA between January 2008 and December 2017, pouchoscopy data were available for 386 patients during a median follow-up period of 4 years. Acute pouchitis occurred in 205 patients (53%), 60 of whom (30%) progressed to chronic pouchitis. Cuffitis and Crohn's disease–like condition (CDLC) of the pouch occurred in 119 (30%) patients and 46 (12%) patients, respectively. In multivariable analysis, female sex was associated with a decreased risk of acute pouchitis, and pre-operative steroid use and medically refractory disease were associated with an increased risk; IBDU was associated with chronic pouchitis; rectal cuff length ≥2 cm and medically refractory disease were associated with cuffitis; age 45–54 at colectomy was associated with CDLC. Rates of pouch failure were similar in chronic pouchitis and CDLC patients treated with biologics and those who were not. Conclusions Inflammatory pouch conditions are common. Biologic use for chronic pouchitis and CDLC does not impact the rate of pouch failure.

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