Topic
Pouchoscopy
About: Pouchoscopy is a research topic. Over the lifetime, 99 publications have been published within this topic receiving 5745 citations.
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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
01 Jan 2019
TL;DR: Pouchoscopy should be routinely used to assess the response to medical, endoscopic, and surgical treatment of pouch disorders, and other endoscopy modalities may be used for further evaluation of pouch-associated disorders.
Abstract: Pouch endoscopy or pouchoscopy is a main modality for the diagnosis and differential diagnosis as well as treatment of ileal pouch disorders. It is important to recognize, evaluation, and photo-document landmarks of anatomy of the pouch and structural, inflammatory, and neoplastic changes. In addition to grading of degree of inflammation, an evaluation of extent, distribution, associated conditions of inflammation is imperative for the differential diagnosis between inflammatory disorders of the pouch, including various phenotypes of pouchitis, Crohn’s disease of the pouch, and cuffitis. Pouchoscopy should be routinely used to assess the response to medical, endoscopic, and surgical treatment of pouch disorders. Pouchoscopy with biopsy is the gold standard for surveillance of dysplasia. Other endoscopy modalities, such as upper endoscopy, capsule endoscopy, and image-enhanced endoscopy may be used for further evaluation of pouch-associated disorders.
01 Jan 2015
TL;DR: Ileal pouch-anal anastomosis or “IPAA” is a surgical procedure to treat ulcerative colitis, where the entire colon is removed and the last portion of the small intestine is formed into a “pouch” and is attached internally to the anal sphincter muscle.
Abstract: Ileal pouch-anal anastomosis or “IPAA” is a surgical procedure to treat ulcerative colitis, where the entire colon is removed. The last portion of the small intestine is formed into a “pouch” and is attached internally to the anal sphincter muscle. This procedure is often done in two or three stages and usually involves a temporary ileostomy for 12–24 weeks, depending on the number of stages.
TL;DR: Comprehensive literature review demonstrates that this case illustrates the classical clinical, radiologic, endoscopic, and histopathologic findings in PI, a relatively rare syndrome.
Abstract: Prepouch ileitis (PI) is an uncommon complication of ileal pouch anal anastomosis (IPAA) and restorative proctocolectomy (RPC) for treatment of refractory ulcerative colitis (UC). A case is reported of PI in a 16-year-old girl who presented with severe UC that was initially stabilized with infliximab therapy but re-presented 1 year later with severe UC, refractory to infliximab and corticosteroid therapy, which required IPAA and RPC. Her symptoms resolved postoperatively, but she re-presented 1 year later with 10 loose, bloody, bowel movements/day and involuntary 6-Kg weight-loss. Computerized tomographic enterography showed focal narrowing and mucosal enhancement of the pouch and focal narrowing, abnormal mucosal enhancement, and mural thickening of the prepouch ileum. Pouchoscopy revealed exudates and ulcerations in both the pouch and prepouch ileum up to 50 cm proximal to pouch, as confirmed by histopathology of pouch and ileal biopsies. Capsule endoscopy revealed no small intestinal lesions beyond 50 cm from the pouch. She required antibiotics, hydrocortisone enemas, and eventually azathioprine to control her symptoms. She remains asymptomatic 4 years later while chronically administered azathioprine therapy. Comprehensive literature review demonstrates that this case illustrates the classical clinical, radiologic, endoscopic, and histopathologic findings in PI, a relatively rare syndrome.