Abstract
This study analyzed the characteristics and outcome of salvage procedures in 30 pouch related complications (PRC) after restorative proctocorectomy with ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC). Mean age at the development of PRC was 33.0 years. The mean time between the first IPAA and the onset of PRC was 2.2 years. As complaints of PRC, perineal discharge, melena, anal pain and low back pain occurred in 21, 9, 7, and 4 patients respectively. The pattern of PRC included refractory perianal fistula in 14, pelvic abscess in 13, anastomotic stenosis in 2, and sphincter damage in 1. The 30 PRC patients received a mean of 2.7 (range, 1-7) salvage procedures, of whom 25 required temporary diverting ileostomy. Sixteen patients received seton drainage 24 times. Seven patients received re-do IPAA, 2 of whom ultimately underwent closure of ileostomy. Six patients underwent pouch excision.
There were 4 patients who had been diagnosed with indeterminate colitis or Crohn's disease and PRC during the course of the salvage strategies. Although the course of PRC after IPAA varies, it is often possible to salvage the pouch by an appropriate strategy.
