Portal Vein Thrombi After Ileal Pouch-Anal Anastomosis: Its Incidence and Association with Pouchitis

179

127

Diseases involving the hepatopancreatobiliary (HPB) system are frequently encountered in patients with inflammatory bowel disease (IBD). Hepatobiliary manifestations constitute some of the most common extraintestinal manifestations of IBD. They appear to occur with similar frequency in patients with Crohn's disease or ulcerative colitis. HPB manifestations may occur in following settings: 1) disease possibly associated with a shared pathogenetic mechanism with IBD including primary sclerosing cholangitis (PSC), small-duct PSC/pericholangitis and PSC/autoimmune hepatitis overlap, acute and chronic pancreatitis related to IBD; 2) diseases which parallel structural and physiological changes seen with IBD, including cholelithiasis, portal vein thrombosis, and hepatic abscess; and 3) diseases related to adverse effects associated with treatment of IBD, including drug-induced hepatitis, pancreatitis (purine-based agents), or liver cirrhosis (methotrexate), and reactivation of hepatitis B, and biologic agent-associated hepatosplenic lymphoma. Less common HPB manifestations that have been described in association with IBD include autoimmune pancreatitis (AIP), IgG4-associated cholangitis (IAC), primary biliary cirrhosis (PBC), fatty liver, granulomatous hepatitis, and amyloidosis. PSC is the most significant hepatobiliary manifestation associated with IBD and poses substantial challenges in management requiring a multidisciplinary approach. The natural disease course of PSC may progress to cirrhosis and ultimately require liver transplantation in spite of total proctocolectomy with ileal-pouch anal anastomosis. The association between AIP, IAC, and elevated serum IgG4 in patients with PSC is intriguing. The recently reported association between IAC and IBD may open the door to investigate these complex disorders. Further studies are warranted to help understand the pathogenesis of HPB manifestations associated with IBD, which would help clinicians better manage these patients. An interdisciplinary approach, involving gastroenterologists, hepatologists, and, in advanced cases, general, colorectal, and transplant surgeons is advocated.

“…164 Portal vein thrombosis has been seen in UC patients following restorative proctocolectomy. [165][166][167] (Fig. 5).…”

Section: Portal Vein Thrombosis and Hepatic Abscessmentioning

confidence: 91%

Section: Portal Vein Thrombosis and Hepatic Abscessmentioning

confidence: 99%

Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease

Navaneethan¹,

Shen²

2010

179

127

“…28,29 Asymptomatic portal vein thrombosis may occur in up to 40% of patients undergoing IPAA surgery. 30 The clinical spectrum associated with portal vein thrombosis is variable, ranging from subtle symptoms to fever, vomiting, abdominal distension, pain, and ileus. Indeed, portal vein thrombosis can present with severe pain imitating an acute abdomen and should always be considered in patients that deteriorate in the postoperative period, especially those who have already been discharged from the hospital.…”

Section: Small Bowel Obstructionmentioning

confidence: 99%

Perioperative complications in inflammatory bowel disease

Beddy

Dozois

Pembérton

2011

Almost 50% of patients with inflammatory bowel disease (IBD) will undergo surgery for their disease at some stage of its clinical course. Complications seen following surgery may occur early or late in the postoperative period. Patient factors, including active inflammatory disease, malnutrition, and use of immunosuppressant medications, make these patients a challenging surgical group and at increased risk for surgical complications. The purpose of this review is to characterize the complications that are commonly seen following surgery in patients with IBD and to discuss the surgical and patient factors that may influence their development.

“…Furthermore, 2 patients in the study group had a history of perioperative portal vein thrombi treated with anticoagulant therapy, which has been reported to be associated with pouchitis. 41 Finally, the majority of patients with ischemic pouchitis in this study were male, suggesting that estrogen may not play a major role in pouch ischemia.…”

Section: Discussionmentioning

confidence: 96%

Asymmetric endoscopic inflammation of the ileal pouch: A sign of ischemic pouchitis?

Shen¹,

Plesec²,

Remer³

et al. 2010