[Pouchitis after ileo-anal anastomosis with a reservoir in hemorrhagic rectocolitis]

Abstract

DEFINITION AND FREQUENCY: An ileoanal anastomosis with creation of an ideal pouch is proposed as the treatment for familial adenomatous polyposis and ulcerative hemorrhagic rectocolitis. The ideal pouch may become inflammatory in 10 to 30% of the cases. The diagnosis of pouchitis is based on a clinical, endoscopid and histological criteria.

Pathogenic hypotheses: Pouchitis is a late complication, mainly after ileoanal anastomosis for ulcerative rectocolitis. The pathogenic mechanism is a subject of debate. Fecal stasis, bacterial pollution, mucine secretion and the underlying inflammatory disease could be involved.

Treatment: Antibiotics active against anaerobic bacteria, such as metronidazole, are generally given. In case of failure, common antiinflammatory agents used in inflammatory bowel disease are indicated.