COMPLICATIONS OF ILEAL J-POUCH
Early complications:
• Bowel obstruction
• Pouch bleeding
• Pelvic and wound sepsis
• Transient urinary dysfunction
• Dehydration from high output stoma
Late complications:
• Stricture of anastomosis
• Fistula (anal and vaginal)
• Poor anorectal function
• Pouchitis (18 & 48% at 1 and 10 years)
• Prolapse
Outcome of pouch-related complications after ileal pouch-anal anastomosis
Dayton, MT, Larsen KP, 1997
• Retrospectively looked at 510 IPPA
• 5.3 % complication associated with pouch (n=27)
• 81% had UC
• Proximal J pouch leak (41%)
o Present with frank peritonitis or chronic abdominal pain (walled off leak)
o All pouches preserved; 10 exploratory laparotomy and stapling of leak & 1
drained by IR
o Oversew the blind limb?
• Distal J pouch or anastomotic leak (30%)
o Half required surgery & half treated by IR & IV antibiotics
o All pouches preserves with more BM per day
• Anastomotic disruption (7.4%)
• Recurrent pouch fistulae (7.4%)
• Megapouch (7.4%)
• High stool frequency
• Loss of continence
• Factors that potentially affects pouch leaks
o Moderate to severe ulcerative colitis
o Tension on ileal-pouch anastomosis
Ileo-anal pouch operation: Long-term outcome with or without diverting ileostomy
Mowschenson, PM, Critchlow JF, Peppercorn MA 2000
• 102 underwent single stage…9.8% leak
• Unable to identify factors that predispose to leak
• Diverting ileostomy does not prevent leak but lessen their presentation
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Effect of high dose steroids on anastomotic complications after proctocolectomy with ileal
pouch-anal anastomosis (Lake et al 2004)
Diagnosis of pouch leak
• CT scan
• Pouchagram
• EUA
Management
• Drainage of collection
• Antibiotics
• Diverting ileostomy and exploration of pouch
Hugo St. Hilaire, M.D.
June 6, 2005
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