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Review
. 2021 May;23(5):1193-1204.
doi: 10.1111/codi.15553. Epub 2021 Feb 15.

The pouch behaving badly: management of morbidity after ileal pouch-anal anastomosis

Mohammed Deputy  1   2 , Jonathan Segal  1   2 , Lillian Reza  1   2 , Guy Worley  1   2 , Samuel Costello  3   4 , Elaine Burns  1   2 , Omar Faiz  1   2 , Susan Clark  1   2 , Ailsa Hart  1
Affiliations
Review

The pouch behaving badly: management of morbidity after ileal pouch-anal anastomosis

Mohammed Deputy et al. Colorectal Dis. 2021 May.

Abstract

Aim: Ileal pouch-anal anastomosis (IPAA), or a 'pouch', allows restoration of intestinal continuity after proctocolectomy for ulcerative colitis or familial adenomatous polyposis. Most patients have a good long-term outcome after IPAA, but in a significant proportion the functional outcome and quality of life are unsatisfactory. We term this outcome 'the pouch behaving badly'. Managing this, especially one is when unfamiliar with the possible underlying pathologies, is a challenge for both patient and clinician. We aim to outline the clinical approach to the pouch behaving badly, highlighting key aspects of investigation and management.

Method: This is a narrative review of the literature covering the investigation and management of postoperative complications and morbidity after IPAA.

Results: Management of the pouch behaving badly requires a careful clinical assessment. The patient may present with multiple symptoms and a clear picture of the symptomatology and past history should be constructed before thorough examination and specialist investigation. We divide the pathology that underlies this clinical scenario into surgical, inflammatory, mechanical, functional and dysplastic causes and outline the investigation and management of each one.

Conclusion: The pouch behaving badly is a challenging problem for both patient and clinician. A detailed clinical assessment with careful specialist investigation is key to diagnosing the underlying pathology. We stress the importance of patient-centred care - the aim is to improve quality of life.

Keywords: IPAA; familial adenomatous polyposis; ileoanal pouch; ulcerative colitis.

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References

REFERENCES

    1. Parks AG, Nicholls RJ Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978;2(6130):85-8. https://doi.org/10.1136/bmj.2.6130.85
    1. Derikx LAAP, Nissen LHC, Smits LJT, Shen B, Hoentjen F Risk of neoplasia after colectomy in patients with inflammatory bowel disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016;14(6):798-806.e20. https://doi.org/10.1016/j.cgh.2015.08.042
    1. Moertel CG, Hill JR, Adson MA Surgical management of multiple polyposis: the problem of cancer in the retained bowel segment. Arch Surg. 1970;100(4):521-6. https://doi.org/10.1001/archsurg.1970.01340220197033
    1. Bess MA, Adson MA, Elveback LR, Moertel CG. Rectal cancer following colectomy for polyposis. Arch Surg. 1980;115(4):460-7. https://doi.org/10.1001/archsurg.1980.01380040084015
    1. Zittan E, Ma GW, Wong-Chong N, Milgrom R, McLeod R s, Silverberg M, et al. Ileal pouch-anal anastomosis for ulcerative colitis: a Canadian institution’s experience. Int J Colorectal Dis. 2017;32(2):281-5. https://doi.org/10.1007/s00384-016-2670-y

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