Showing papers on "Pouchoscopy published in 2007"

Long-axis rotational volvulus in a W ileoanal pouch: an unusual but potentially preventable problem. Report of a case.

Abstract: This study was designed to report long-axis rotational volvulus, an unusual long-term complication of restorative proctocolectomy. A MEDLINE search using the keywords, pouch volvulus, pouch complications, ileoanal pouch volvulus, restorative proctocolectomy volvulus, restorative proctocolectomy complications, W-pouch, and early and late complications, was performed and yielded no previous reports. We describe pouch gangrene secondary to volvulus in a W-pouch four years after restorative proctocolectomy for ulcerative colitis. Early recognition by clinical features, pouchoscopy, and soluble contrast studies are crucial if pouch salvage by pouchpexy is to be successful. Acute necrosis of the ileoanal pouch caused by long-axis rotational volvulus is an important, but uncommon, cause of life-threatening acute abdomen after restorative proctocolectomy. Prophylactic pouchpexy at the time of pouch construction or salvage pouchpexy after early diagnosis of the at-risk pouch are important considerations to avoid loss of the pouch.

Tubulovillous adenoma in an Indiana pouch urinary diversion managed by endoscopic resection.

Abstract: We present a case of a tubulovillous adenoma in an Indiana pouch managed by endoscopic resection. A 66-year-old male underwent a cystectomy with creation of an Indiana pouch urinary diversion for invasive small cell carcinoma of the bladder. Seven years following his initial surgery, the patient noted several episodes of gross hematuria. The evaluation revealed a 2.5 cm tubulovillous adenoma with high-grade dysplasia within the Indiana pouch. The patient had significant comorbidities precluding an open operative procedure. He underwent en endoscopic resection of the tumor, and subsequently has been managed with surveillance pouchoscopy, biopsies, and fulguration every 3 months.

Intra-operative pathological diagnosis of chronic ulcerative colitis in the two stage ileal pouch anal anastomosis.

Abstract: Objective The definitive diagnostic biopsy for chronic ulcerative colitis (CUC) is the colon itself. Simultaneous colectomy and ileal pouch anal anastomosis (IPAA) means that the colon only becomes available for pathological assessment intra-operatively. We examined the role of intra-operative pathological assessment including frozen section in distinguishing between CUC and Crohn's colitis, inpatients undergoing simultaneous colectomy and IPAA. Method Prospective study of 13 patients undergoing simultaneous colectomy and IPAA between Jan 1992 and April 1999. Resected colon was sent for pathological assessment intra-operatively in all 13 patients. Comparison was made between final histology and frozen section. Patient outcome and pouch function was recorded prospectively. Results Thirteen patients, M:F 5:8, mean age 41 years (range 20–56). Intra-operative pathological assessment including frozen section diagnosed CUC in nine patients, Crohn's disease in two patients and indeterminate colitis in two patients. The two Crohn's patients had subtotal colectomy and ileostomy. The nine CUC patients and two indeterminate colitis patients underwent IPAA. There was complete agreement between intra-operative assessment including frozen section and the final histopathology. At a median follow up of 31 months (8–58 months) all pouches were intact with good function. There has been no evidence of Crohn's disease on subsequent pouchoscopy and pouch biopsy. Conclusions Pathological assessment, including frozen section of the colon, intra-operatively is a useful adjunct to surgical decision making in those patients undergoing simultaneous colectomy and IPAA.