J Pouch: Imaging Findings, Surgical Variations, Natural History, and Common Complications

Abstract

Ileal pouch-anal anastomosis, or J pouch, surgery has become the procedure of choice for treatment of medically refractory ulcerative colitis and familial adenomatous polyposis. Overall, this operation is associated with a low rate of postoperative morbidity and good long-term function. However, when complications develop, there is a heavy reliance on imaging to facilitate an accurate diagnosis. Reported postoperative complication rates range from 5% to 35%. Complications generally can be categorized as structural, inflammatory, or neoplastic conditions. Structural complications include leaks, strictures, afferent and efferent limb syndromes, and pouch prolapse. Inflammatory conditions include cuffitis, pouchitis, and Crohn disease of the pouch. In addition, a variety of neoplastic conditions can develop in the pouch. Overall, pouchitis and leaks are the most common complications, occurring in up to 50% and 20% of individuals, respectively. Many imaging modalities are used to evaluate the J pouch and associated postoperative complications. The indications and various surgical techniques for J pouch surgery, normal postoperative appearance of the pouch, and most common associated complications are reviewed. In addition, the various imaging findings associated with J pouch surgery are described and illustrated. The radiologist's familiarity with the potential complications of the pouch can facilitate appropriate imaging, hasten an accurate diagnosis, and aid in rendering proper management. RSNA, 2018.

Physical and Metabolic Changes after Ileal Pouch-anal Anastomosis: A Case Study

“…The patient had several complications, which resulted in various symptoms that included incontinence, sleep disruption, fatigue, increased inflammatory markers, fever, and malaise, all of which likely contributed to the reductions in physical activity and reduced overall well-being. Postoperative complications of this nature are fairly common after this procedure, and previous research has indicated that nearly 30% to 45% of patients have postoperative perianal complications, such as incontinence, high frequency of output, abscesses, fistulas [7,14] and pouchitis (in up to 50% of patients) [7].…”

“…The procedure is typically done as a three-step surgical process, which can be completed over several months or years. The second surgery is often considered the most invasive and physically challenging of the three, as this step requires the creation of the anastomosis (J-pouch) and the removal of any remaining colon and rectum [7].…”

Successful Closure of the Tip of the “J” Fistula of the Ileal Pouch With Double Over-the-Scope Clips

“…5 Postoperative complications occur in 5% to 35% of the cases, including pouchitis, cuffitis, anastomotic strictures, and leaks, fistulae, and irritable pouch syndrome. 1,4,6 Rates of pouch leaks range from 5% to 18%. 1 The staple or suture lines at the stoma closure site, tip of the "J," pouch body, and pouch-anal anastomosis are common sites for leaks 6,7 which can lead to pouch failure.…”

“…1,4,6 Rates of pouch leaks range from 5% to 18%. 1 The staple or suture lines at the stoma closure site, tip of the "J," pouch body, and pouch-anal anastomosis are common sites for leaks 6,7 which can lead to pouch failure. 2,8 Endoscopic therapy has become an effective intervention for structural pouch complications such as strictures, obstructions, fistulae, and leaks.…”

Lower fecal pH may be a novel indicator of pouchitis after IPAA in patients with FAP or metachronous Lynch syndrome

“…Therefore, a relatively reliable and widely accepted criterion, the modified pouchitis disease activity index (mPDAI), was created to address this complex issue . To supplement the mPDAI, many studies have focused on finding an innovative and convenient method to indicate pouchitis . The inflammatory nature of pouchitis is usually ignored by researchers.…”