Restorative proctocolectomy with ileal reservoir: a pathophysiological assessment.

Abstract

SUMMARY A metabolic and physiological assessment was carried out in 14 patients who had undergone restorative proctocolectomy with ileal reservoir more than six months previously. The haemoglobin was normal in all but one and plasma electrolytes and serum albumin, calcium, phosphorus, and red cell folate estimations were normal in all. Five patients had low serum iron levels of whom one had an iron deficiency anaemia. The 24 hour faecal fat output was normal in all patients and there was no case of vitamin B12 malabsorption as judged by the Schilling test, although four patients had marginally low values. These were not associated with increased bacterial counts in the faeces within the reservoir and there was no evidence to support a diagnosis of stagnant loop syndrome. Inflammation of the reservoir mucosa was, however, associated with higher counts of aerobic bacteria than in cases where inflammation was absent. Subtotal villous atrophy or inflammation was seen in biopsies of the reservoir in six patients. The mean faecal output per 24 hours was 659±259 g and the mean reservoir volume was 330±78 ml. Mean resting anal canal pressure was significantly lower in patients with a mucous leakage per anum than in those without, while manometry of the reservoir showed no alteration of pressure over a period of one hour before and after a meal. A positive rectosphincteric reflex was observed in nine patients.

Restorative Proctocolectomy with Ileo-anal Reservoir, a Histopathological, Histochemical, and Electron Microscopic Study

“…Transformation to a glandular morphology resembling colonic mucosa is common [7]. Histochemical changes in pouch mucin from sialo to sulphomucin are seen in pouches with villous atrophy [5].…”

Colonic transformation of ileal pouch–anal anastomosis and of the distal ileum: MRI findings

“…This process is characterised by histological and histochemical changes, such as severe villous atrophy accompanied by pronounced crypt hyperplasia and elongation [2][3][4][5][6][7]. Histochemical studies using mucin staining have shown a change from small intestinal sialomucin to colorectal-type sulfomucin [6,7].…”

“…Because histopathological studies in patients with IPAA have demonstrated the transformation of ileal pouch mucosa into colonic mucosa [2][3][4][5] and chemical studies have shown a change of pouch mucin from small bowel-type sialomucin to colorectal sulfomucin [6,7], a theory of colonic transformation of the ileal pouch mucosa has been developed. As a result of the post-operative adaptation of the ileum to its function as neorectum, deep clefts in the ileal pouch mucosa resembling rectal valves may occasionally be observed during fluoroscopic contrast examination (pouchography).…”

Benefit of antibiotic therapy on pouchitis after ileal pouch anal anastomosis: A systematic review and meta-analysis of clinical trials

“…Pouchitis is currently being defined with a clinical, endoscopic and histologic scoring system (PDAI) as the disease activity index of more than 7. The incidence of pouchitis is reported as 7% to more than half of the patients whom undergo IPAA operation [2,[4][5][6][7].…”