Original Article

International Journal of Colorectal Disease

, Volume 15, Issue 1, pp 49-53

First online:

Outcome of ileal pouch after secondary diagnosis of Crohn’s disease

  • V. PeyrègneAffiliated withDepartment of General and Thoracic Surgery, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand-Revoyet, 69495 Pierre-Bénite Cedex, France e-mail: francogi@uheim.univ-lyon1.fr Tel.: +33-4-78861385 Fax: +33-4-78863343
  • , Y. FrancoisAffiliated withDepartment of General and Thoracic Surgery, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand-Revoyet, 69495 Pierre-Bénite Cedex, France e-mail: francogi@uheim.univ-lyon1.fr Tel.: +33-4-78861385 Fax: +33-4-78863343
  • , F.-N. GillyAffiliated withDepartment of General and Thoracic Surgery, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand-Revoyet, 69495 Pierre-Bénite Cedex, France e-mail: francogi@uheim.univ-lyon1.fr Tel.: +33-4-78861385 Fax: +33-4-78863343
  • , J.-L. DescosAffiliated withDepartment of Hepatogastroenterology, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand-Revoyet, 69495 Pierre-Bénite Cedex, France
  • , B. FlourieAffiliated withDepartment of Hepatogastroenterology, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand-Revoyet, 69495 Pierre-Bénite Cedex, France
  • , J. VignalAffiliated withDepartment of General and Thoracic Surgery, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand-Revoyet, 69495 Pierre-Bénite Cedex, France e-mail: francogi@uheim.univ-lyon1.fr Tel.: +33-4-78861385 Fax: +33-4-78863343

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Abstract 

Ileal-pouch anal anastomosis is sometimes performed inappropriately in Crohn’s disease patients. The aim of this study was to evaluate long-term results in this subset. In 54 ileal-pouch anal anastomoses performed between 1985 and 1997 for CUD the patient was eventually diagnosed as having Crohn’s disease in seven cases. A retrospective review was performed. Definitive diagnosis was established on histopathology, endoscopy, and clinical presentation. The principal outcome factors were pouch failure, reason for failure, and functional results in cases of retained pouch. Patients ranked their quality of life between 1 and 10. We found three failures due to pelvic abscess, anoperineal disease, and anovulvar fistula. The pouch was excised in the latter patient; four patients retained their pouch. Functional results were good in the four (7 year follow-up): 7.25 bowel movements per day, ability to discriminate flatus from feces in three, soiling in one, urgency in one, perianal pad in one, ability to differ bowel movement for 66 min, diet, and antidiarrheal medication all four, pouchitis in one, sexual troubles in one woman, no urinary or obstetric trouble. Quality of life was judged satisfactory by six of the seven patients. Our 13% rate of inadvertent ileal-pouch anal anastomosis is higher than results usually reported. This difference is explained by the diagnostic criteria, whose validity is controversial. Three-stage surgery to decrease inadvertent restorative coloproctectomy is worth considering. Even if results are good when the pouch is functioning, Crohn’s disease remains a contraindication to ileal-pouch anal anastomosis because of its high rate of failure and excision.

Keywords Ileal pouch-anal anastomosis Crohn’s disease Ileal pouch Functional results