GASTROENTEROLOGY ARTICLE OF THE WEEK
October 22, 2009
Shen B, Remzi FH, et al. A proposed classification of ileal pouch disorders and associated complications after protocolectomy. Clin Gastroenterol Hepatol 2008;6:145-158.
1. Pelvic sepsis after protcolectomy
a. Most often requires surgical correction
b. More common in patients with staple gun –sewn anastomosis
c. Associated with anastomotic leak in over 80%
d. More common in patients with PSC
e. Overall incidence of 5% to 20%, in 30% will eventually lead to pouch failure.
2. Pouchitis
a. Is the most common long-term sequeale of IPAA.
b. Is as common in UC patients as in FAP patients who undergo this surgery
c. Endoscopic appearance correlates with severity of symptoms
d. Is more common in PSC patients
e. Symptomatic pouchitis may occur in endoscopically normal pouches with histologic evidence of inflammation
True or False
3. The onset of pouch sinuses should raise the possibility of Crohn’s disease
4. Pouch-vaginal fistula is one of the most common causes of pouch failure
5. Cuffitis, like pouchitis, responds best to antibitotic therapy
6. Strictures after IPAA occur is about 11% of cases, endoscopic dilation is contraindicated
7. Patients are risk for cuffitis are those who underwent a stapled anastomosis after extensive mucosectomy
8. In ulcerative colitis, infertility is less common after IPAA than with continued medical therapy
9. Backwash ileitis in a pouch usually presents as discrete ulcers with intervening normal mucosa and structuring
10. NSAID use increases risk of pouch strictures and pouchitis
11. B-12 deficiency is a more common cause of anemia than iron deficiency in patients that have undergone IPAA.
12. Pouchitis that manifests endoscopically as ulcers only in the afferent limb of a J pouch is typically seen with ischemic pouchitis.
13. Inflammation of the pouch with granulomas detected on biopsies done near the suture line is diagnostic for Crohn’s disease.