Surgery for pouch inflow limb–related complications: Crohn’s disease or something else?

Plietz, Michael; Mui, Alex; Kayal, Maia; Gross, Benjamin D.; Hao, Yansheng; Rubin, Peter; Polydorides, Alexandros; Jochen, Bauer

doi:10.1007/s00384-022-04124-8

Cited by 2 publications

(1 citation statement)

References 20 publications

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“…26 In one study, resected afferent limb specimens in prior UC patients found that 56% had confirmed CD on pathology with 69% with a change of diagnosis to CD. 34…”

Section: Differential Diagnosismentioning

confidence: 99%

Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies

Huang,

Abeshouse,

Lee

et al. 2024

Clin Colon Rectal Surg

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De novo Crohn's disease (CD) of the pouch or Crohn's-like Ileal Pouch Illness (CLIPI) is an increasingly common occurrence in an ever-growing ileal pouch population. Although currently undetermined if a subset of classic CD or a completely new entity, it primarily affects the prepouch afferent limb, pouch, and rectal cuff. Symptoms can mimic other more common disorders, such as pouchitis, and requires a thorough workup, including pouchoscopy with biopsy and often cross-sectional imaging, for the diagnosis to be made. There is an increased risk of long-term pouch failure in this population. Treatment is typically dependent upon the disease phenotype with surgical management considered in a step-up fashion. Medical management is primarily performed with “biologics,” such as antitumor necrosis factor agents, although data are limited due to the lack of randomized controlled trials. Surgical management for CLIPI can include endoscopic, anorectal, and abdominal approaches to assist as “pouch-salvage strategies.” The performance of advanced pouch-salvage techniques in the CLIPI population requires careful patient selection and should preferably be performed at high-volume pouch centers.

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“…26 In one study, resected afferent limb specimens in prior UC patients found that 56% had confirmed CD on pathology with 69% with a change of diagnosis to CD. 34…”

Section: Differential Diagnosismentioning

confidence: 99%

Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies

Huang,

Abeshouse,

Lee

et al. 2024

Clin Colon Rectal Surg

Self Cite

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Salvage surgery for pouch-related complication after ileal pouch–anal anastomosis: a report of two cases

Izutani,

Ogino,

Sekido

et al. 2024

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Background Pouch-related complications (PRCs), such as pelvic abscesses and perianal complex fistulas, can occur after ileal pouch–anal anastomosis (IPAA) in ulcerative colitis (UC). They are often difficult to treat and require salvage surgery. We report two cases of PRC associated with fistulas. Case presentation First case: A 38-year-old man was diagnosed with UC at age 26 years. Four months after the diagnosis of UC, the patient underwent hand-assisted laparoscopic restorative proctocolectomy, IPAA, and ileostomy for acute fulminant UC. Two years after the closure of the ileostomy, the patient developed a perianal abscess and underwent ileostomy reconstruction. He was referred to our department at 35 years of age, because his symptoms did not improve despite repeated seton drainage of a complicated perineal fistula. We diagnosed PRC with a pelvic abscess and complicated pouch fistula and performed salvage surgery. This diagnosis was revised to Crohn’s disease. Second case: A 50-year-old man was diagnosed with UC at age 18 years and was administered high doses of steroids; however, his symptoms did not improve. He underwent restorative proctocolectomy, IPAA, and ileostomy at another hospital. The ileostomy was closed, and his condition stabilized thereafter. At 35 years of age, perianal pain developed, and he was diagnosed with a complicated pouch–perineal fistula. A fistula was observed near the staple line of the ileal end closure on the head side of the pouch. Reconstruction of the ileostomy and seton drainage were performed; however, his symptoms did not improve, and he was referred to our hospital. We diagnosed PRC with a pelvic abscess and a complicated pouch fistula and performed salvage surgery. The resected specimen showed strictures in two locations: at the oral site of the afferent limb (at the pouch) and at the IPAA. Both patients returned to society and are currently outpatients. Conclusions We encountered two cases of PRC after IPAA that did not improve with seton drainage or ileostomy. Pouch resection was performed after considering the patient’s quality of life and reintegration into society.

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Surgery for pouch inflow limb–related complications: Crohn’s disease or something else?

Cited by 2 publications

References 20 publications

Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies

Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies

Salvage surgery for pouch-related complication after ileal pouch–anal anastomosis: a report of two cases

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