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Judging the J pouch: a pictorial review

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Abstract

Restorative total proctocolectomy with ileal pouch-anal anastomosis is the surgery of choice for patients with medically refractory ulcerative colitis, ulcerative colitis with high-grade dysplasia or multi-focal low-grade dysplasia, and for patients with familial adenomatous polyposis. The natural history of the surgery is favorable, and patients generally experience improved quality of life and acceptable long-term functional outcome. However, some patients experience significant long-term morbidity from early and/or late pouch-related complications. When complications arise, radiologists must understand the advantages and disadvantages of the various imaging modalities that can be used to assess the pouch. Radiologist familiarity with the surgical technique, pouch anatomy, and imaging appearance of the various potential early and late complications will help facilitate appropriate clinical and surgical decision-making. This review provides an anatomic-based imaging review of the pouch and pouch-related complications, including numerous illustrative fluoroscopic and cross-sectional imaging examples.

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Acknowledgements

The authors acknowledge the assistance of Sonia Watson, PhD, in preparation of the manuscript.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Shannon P. Sheedy, David J. Bartlett, Steven W. Trenkner, Jeff L. Fidler, Wendaline M. VanBuren, Joshua D. Reber & Joel G. Fletcher

  2. Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    Amy L. Lightner

  3. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    David H. Bruining

  4. Department of Radiology, Mayo Clinic, Scottsdale, AZ, USA

    Christine O. Menias

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  1. Shannon P. Sheedy
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Sheedy, S.P., Bartlett, D.J., Lightner, A.L. et al. Judging the J pouch: a pictorial review. Abdom Radiol 44, 845–866 (2019). https://doi.org/10.1007/s00261-018-1786-7

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