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. 2022 Apr;37(4):879-885.
doi: 10.1007/s00384-022-04124-8. Epub 2022 Mar 17.

Surgery for pouch inflow limb-related complications: Crohn's disease or something else?

Michael C Plietz  1 , Alex Mui  2 , Maia Kayal  3 , Benjamin D Gross  2 , Yansheng Hao  4 , Peter Rubin  3 , Alexandros D Polydorides  4 , Joel Bauer  2
Affiliations

Surgery for pouch inflow limb-related complications: Crohn's disease or something else?

Michael C Plietz et al. Int J Colorectal Dis. 2022 Apr.

Abstract

Purpose: A total proctocolectomy with subsequent creation of an ileal-pouch, such as a J-pouch or a Kock pouch, has been the most common surgery performed for ulcerative colitis (UC). A small portion of these patients will develop complications with the inflow limb into the pouch requiring operative intervention. The objective was to establish a better understanding as to the pathological mechanism by which these pouch inflow limb problems develop.

Methods: This was a retrospective cohort study conducted at a single tertiary care inflammatory bowel disease (IBD) center. A database was created of all the patients who underwent pouch-related procedures, following completion of their original pouch, between 2006 and 2018. The patients requiring operative resection for inflow limb complications were identified among this cohort. Operative and pathological data were collected.

Results: One hundred seventy-eight UC patients underwent surgeries on their pouches between 2006 and 2018. Sixteen patients required operative resection for inflow limb problems. Reoperations for inflow limb problems included inflow limb resection with pouch excision (n = 4) and inflow limb resection with pouch revision (n = 12). The pathology findings of the inflow limb were consistent with Crohn's disease in 9 patients (56%). Two other patients (total 69%) were eventually diagnosed with Crohn's disease due to other pathological specimens or perianal pathology. The remaining patients had chronic, non-specific enteritis/serositis.

Conclusions: A small proportion of pouch patients will eventually require surgery for inflow limb complications. Among these, there was a high rate of Crohn's disease of the inflow limb and overall change in diagnosis to Crohn's disease (Plietz et al. in Official Journal of the American College of Gastroenterology | ACG 114:S453, 2019).

Keywords: Crohn’s disease; Inflow limb; J-pouch; Pre-pouch ileitis; Ulcerative colitis.

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References

    1. Plietz M, Rubin P, Polydorides A et al (2019) 782 Pathological findings of resected inflow limbs in patients with pouches for ulcerative colitis. Official journal of the American College of Gastroenterology | ACG 114:S453
    1. Kuhn F, Klar E (2015) Surgical principles in the treatment of ulcerative colitis. Viszeralmedizin 31(4):246–250 - PubMed - PMC
    1. Bach SP, Mortensen NJ (2007) Ileal pouch surgery for ulcerative colitis. World J Gastroenterol 13(24):3288–3300 - DOI
    1. Frizelle FA, Burt MJ (1997) Review: the surgical management of ulcerative colitis. J Gastroenterol Hepatol 12(9–10):670–677 - DOI
    1. Sellers MM, Elnekaveh BM, Hahn SJ, Hirten RP, Greenstein AJ (2019) Surgical solutions for refractory J-pouch inlet obstruction. Colorectal Dis 21(6):679–683 - DOI

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