Showing papers on "Pouchoscopy published in 2014"
TL;DR: There is a low level of correlation between clinical and endoscopic and histologic subscores of patients with IPAA; clinical symptoms therefore might not reflect objective evidence of inflammation.
45 citations
TL;DR: Male gender, recent hospitalization, and presurgery antibiotic use were shown to be risk factors for ileal pouch CDI, and Fecal microbiota transplantation may find use in the management of severe or antibiotic refractory CDI-related pouchitis.
31 citations
TL;DR: This case is reported the first case in the literature that a leak from the tip of a J-pouch was endoscopically occluded using a novel over-the-scope clipping system.
11 citations
TL;DR: A case of a poorly differentiated mucinous adenocarcinoma of the pouch following 13 years after IPAA for UC with entirely stapled anastomosis is presented, and all the previous experiences in the published literature are reviewed.
Abstract: Dear Editor: Pouch adenocarcinoma following restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) has been reported and reviewed [1]. Ileal pouchanal reconstruction was introduced for the first time in 1978 by Parks and Nicholls; it is accepted as a standard surgical procedure following total proctocolectomy for ulcerative colitis (UC). With very low mortality and acceptable morbidity, it has largely replaced the permanent ileostomy in these patients. IPAAmay be performed either with a mucosectomy and handsewn anastomosis or with an entirely stapled anastomosis. The onset of an adenocarcinoma in the small residual rectal stump or in the ileal pouch after surgery for UC is a rare occurrence, being that there has been only a few cases reported in the literature. An association of backwash ileitis and chronic pouchitis with pouch cancer has been described [2]. We are presenting here a case of a poorly differentiated mucinous adenocarcinoma of the pouch following 13 years after IPAA for UC with entirely stapled anastomosis, and we have reviewed all the previous experiences in the published literature searching online databases PubMed and Medline. Only indexed published articles were included. The following search terms were used: adenocarcinoma, ileal pouch, restorative proctocolectomy, ulcerative rectocolitis. The patient was a 75-year-old male with a history of ulcerative colitis, diagnosed at age 52, who presented with change in bowel habits with alternating diarrhea and constipation. Because of chronic disease activity and inability to taper high-dose corticosteroids, the patient, at the age of 61 (1999 at our department), underwent total proctocolectomy with ileal pouch-anal anastomosis. This operation consisted of abdominal colectomy, proctectomy in blockwith the meso-rectum up to the plane of the elevators, formation of a j-pouch ileoanal reservoir with stapler, and circumferential ileoanal anastomosis with stapler. The pathology revealed pancolitis, in the absence of other pathological findings. A proximal diverting loop ileostomy was constructed, which was closed 20 weeks later. This patient was evaluated by a gastroenterologist every 3 months for the first year and then every 6 months for the second year. The patient underwent yearly pouchoscopy with no documented episodes of pouchitis, and no biopsies were taken during the first 6 year of follow-up. From 2005, the patient presented with anal pain and diarrhea, and therefore has performed several colonoscopies documenting pouchitis, and the biopsies always proved positive for “inflammation compatible with IBD in phase of activity.” Despite treatment with local and oral antiinflammatory therapy, the patient reported frequent emissions of liquid stools and anal pain. Subsequently, he was treated also with monoclonal antibodies therapy (infliximab), without good response. Endoscopic control in September 2012 showed pouchitis and two perianastomotic pseudopolyps, and the biopsy performed on one of these polyps showed “inflammation and low-grade dysplasia.” The patient underwent a new endoscopic control with biopsies in December 2012 documenting regular anastomosis and persistence of hyperemic and friable mucosa with numerous erosion upstream of the anastomosis and on the side walls with the presence of two pseudopolyps. The biopsy performed M. Luca : P. Matteo : T. Dario (*) :G. Simone :D. C. Giulio : M. Franco General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy e-mail: dario261184@gmail.com
3 citations
TL;DR: The case of a patient, initially thought to have ulcerative colitis, who underwent surgery but subsequently developed perianal CD, highlights that CD can present many years after surgery for apparent UC and CMV pouchitis should be considered as a differential cause of pouchitis.
Abstract: Colectomy with ileoanal pouch formation is usually contraindicated in patients with Crohn's disease (CD) due to the risk of recurrent disease and pouch failure. We report the case of a patient, initially thought to have ulcerative colitis (UC), who underwent such surgery but subsequently developed perianal CD. She presented with diarrhoea and weight loss. Inflammatory markers were raised. Pouchoscopy revealed deep ulcers within the pouch. The main differential diagnoses were idiopathic pouchitis and recurrent CD. However, immunohistochemical staining demonstrated positivity for cytomegalovirus (CMV). Stool frequency, C reactive protein and albumin normalised within 48 h of starting oral valgancyclovir. At 15 weeks, pouch appearances were improved, no histological evidence of CMV was found and baseline pouch function had returned. This case highlights that CD can present many years after surgery for apparent UC. Also, CMV pouchitis should be considered as a differential cause of pouchitis especially as it is treatable with antiviral therapy.
2 citations
TL;DR: Fecalith blocking pouch anastomotic sinus is a rare complication in patients with restorative proctocolectomy and this surgical complication was successfully treated with a carefully planned, stepwise endoscopy approach.
1 citations
TL;DR: Cytomegalovirus infection of the ileoanal pouch is an important differential diagnosis of pouchitis even in non-immunosuppressed patients and can be treated with ganciclovir.
Abstract: Pouchitis often occurs after proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis. It is usually deemed idiopathic and commonly responds to antibacterial therapy. To date, only a few cases of cytomegalovirus pouchitis have been documented, and only a single report describes pouchitis in a case of assumed primary cytomegalovirus infection. A 26-year-old Caucasian woman underwent proctocolectomy and ileal pouch-anal anastomosis for refractory ulcerative colitis and adenocarcinoma. After 28 months she developed bloody diarrhoea, abdominal pain, fever, nausea and general malaise suggesting severe pouchitis. Antibiotic treatment reduced humoral inflammation, but failed to resolve her fever. A pouchoscopy revealed distinct pouchitis, and cytomegalovirus infection was diagnosed from pouch biopsies by polymerase chain reaction as well as conventional histology and immunohistochemistry. The infection was confirmed in her blood by polymerase chain reaction and pp65 antigen test, and was clearly defined as the ‘primary’ infection by serial serological tests. Intravenous treatment with ganciclovir (10mg/kg body weight/day) led to resolution of symptoms and negative cytomegalovirus deoxyribonucleic acid and pp65 within a few days. When symptoms and laboratory evidence of cytomegalovirus infection recurred a few days after completing 20 days of therapy with ganciclovir and valganciclovir, a second course of ganciclovir treatment was initiated. Cytomegalovirus infection of the ileoanal pouch is an important differential diagnosis of pouchitis even in non-immunosuppressed patients and can be treated with ganciclovir.
1 citations