Michael Plietz, MD, Peter Rubin, MD, Alexandros Polydorides, MD, PhD, Alex Mui, BS, Maia Kayal, MD, Yansheng Hao, MD, Joel Bauer, MD
Icahn School of Medicine at Mount Sinai, New York, NY
Introduction: Approximately 30% of ulcerative colitis (UC) patients require surgery during their disease course. Patients will commonly undergo total proctocolectomies with subsequent creation of a “pouch”, such as a J-pouch (pelvic pouch with ileal pouch-anal anastomosis) or a Kock pouch. A small portion of patients undergoing “pouch” procedures for UC will develop severe symptoms related to the inflow limb of the pouch requiring operative intervention. A clear understanding has not been established as to the pathological mechanism by which these pouch inflow problems develop and what pathologic entity they belong.
Methods: A retrospective chart review was conducted at a single tertiary medical center. A database was created of all patients who underwent subsequent pouch-related surgical procedures between 2006 and 2018. Patients with requiring operative intervention of the inflow limb were identified among this cohort. Operative and pathological data were collected.
Results: 178 patients were identified who underwent procedures yielding a surgical pathologic specimen related to their pouch. 15 of these procedures reported significant pathology of the inflow limb to the original pouch (9 J-pouches and 6 Kock pouches), occurring on average of 19.6 years after the creation of the original pouch. The most common diagnosis requiring reoperation was obstruction due to stricture formation (n=11). Reoperations for inflow limb pathology included pouch excision (n=3), inflow limb resection with ileo-pouch anastomosis (n=9), stricturoplasty (n=1), and bypass of the inflow limb (n=1). In addition, 3 patients required a temporary, diverting loop ileostomy as part of their reoperation. The pathologic findings of the inflow limb were consistent with Crohn’s ileitis in 6 patients (40%). 3 other patients (20%) were diagnosed with Crohn’s disease and had diagnostic findings suspicious of Crohn’s on inflow limb pathology. Remaining patients (n=6) were found to have chronic, nonspecific enteritis/serositis. There was one case of poorly differentiated adenocarcinoma.
Discussion: A small proportion of patients who have undergone a “pouch” procedure require eventual surgery for a problem with the inflow limb of the pouch. These patients were found to have a high rate of Crohn’s disease of the inflow limb and overall change in diagnosis to Crohn’s disease.
Citation: Michael Plietz, MD, Peter Rubin, MD, Alexandros Polydorides, MD, PhD, Alex Mui, BS, Maia Kayal, MD, Yansheng Hao, MD, Joel Bauer, MD. P1427 - PATHOLOGICAL FINDINGS OF RESECTED INFLOW LIMBS IN PATIENTS WITH POUCHES FOR ULCERATIVE COLITIS. Program No. P1427. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.