Asymmetric endoscopic inflammation of the ileal pouch: A sign of ischemic pouchitis?

Abstract

Endoscopic asymmetric inflammation of the pouch may represent an ischemia-associated pouchitis with characteristic clinical, radiographic, and histologic features. Its hemodynamic, cellular, and molecular basis of mechanism warrants further study.

Transmural inflammation is not pathognomonic for Crohn’s disease of the pouch

“…However, transmural inflammation is by no means a pathognomonic feature of CD because it also can be seen in radiation injury [26], eosinophilic enteritis [27], diverticulitis [28], and ischemic bowel [29]. Patients with IPAA represent a unique situation in which factors such as surgery-induced ischemic injury [30] and chronic repeat insult from mucosal inflammation can contribute to the development of transmural inflammation.…”

Diagnostic and Management Approach to Pouchitis in Inflammatory Bowel Disease

“…When the etiology suspected is ischemia, the usual finding is a characteristic inflammation pattern of the pouch, compromising only the efferent loop and respecting the afferent loop (43) . These cases are usually related to post-surgical anatomical alterations, such as lack of irrigation of the distal ileum or, excessive tension over the mesentery.…”

Pouchitis

“…These include NSAID use, structural abnormalities of the pouch (ischaemia [5], stricture, fistula, sinus, torsion), infection, and the presence of concurrent autoimmune disorders (such as coeliac disease, autoimmune thyroiditis [44] and PSC [3]). Secondary factors contributing to CARP should be carefully sought and reversed where possible.…”

“…Any tension will produce ischaemia, which may later on contribute to the development of CARP [5]. Any tension will produce ischaemia, which may later on contribute to the development of CARP [5].…”