Results of the pelvic-pouch procedure in patients with Crohn's disease

Abstract

The pelvic-pouch procedure has become a standard operation for selected patients with ulcerative colitis, but is contraindicated in patients with Crohn's disease at our institution. However, the distinction between ulcerative colitis and Crohn's colitis can sometimes be difficult, if not impossible. Between January 1982, and March 1989, 272 patients with ulcerative colitis underwent pelvic-pouch procedures at our institution. Nine (3.5 percent) of these patients eventually were found to have Crohn's disease. The records of these patients were examined to assess their clinical outcome and complication rate. There were five females and four males with a mean age of 28.8 years. In five patients (Group I) the diagnosis of Crohn's disease was made postoperatively on histologic examination of the rectum. The ileostomy was closed in all patients. Two developed complications necessitating excision of the pouch. Three patients are well. In the other four cases (Group II) the mean time to diagnosis was 2.5 years after the pouch procedure. Three patients developed pouch-vaginal fistula, and one multiple anal fissures and stenosis. Two required excision of the pouch whereas two have a functioning pouch but with a persistent pouch-vaginal fistula (n = 1) or anal fissures (n = 1). Overall, four patients have had their pouches removed, and five patients have functioning pouches: three with no complications and two with persistent perianal disease. Thus, we would conclude that the pelvic-pouch procedure should not knowingly be performed in patients with Crohn's disease because of the high associated complication rate.

Family History and Serology Predict Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

“…Although the presence of granulomas is conclusive, 41 many studies have also included 'minor' pathologic criteria such as transmural inflammation, discontinuous disease, and fissuring ulcers in the surgical specimen to establish the diagnosis of CD immediately after colectomy. 7,9,12,15,16,34,39,[42][43][44][45][46][47] We consider patients with these minor criteria to have IC and not CD since these features can not only be observed in fulminant UC but may also reflect treatment effect. Furthermore, we found no significant difference in clinical outcome (i.e., CD development) after IPAA between the UC, IBD-U, and IC patient subgroups.…”

Full Mucosal Proctectomy Initiated below the Dentate Line May Prevent the Development of a Perianal Fistula after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

“…In the worst case, these options include a permanent defunctioning ileostomy or excision of the pouch [6,20,30]. In our study, we excluded patients with preoperative perianal fistulae because these complications significantly increase the risk of developing an ileoanal anastomotic leak and postoperative perianal complications [31]. Moreover, late perianal problems after IPAA are usually considered indicative of Crohn's disease [32].…”

Surgery and diagnostic imaging in abdominal Crohn’s disease

“…The clinical picture in these cases is characterized by inflammatory disease that is poorly controlled with medication, similar to that of ulcerative colitis. In fact, the differential diagnosis may be difficult based on endoscopic findings alone, unless there are also extracolic lesions that point to Crohn's disease [104,105]. The clinical course of this type of disease also resembles that of ulcerative colitis: surgery may be required for an acute evolution that results in toxic megacolon [106], but in most cases surgery is performed because the disease cannot be managed medically.…”