Abstract
Pouch ileitis is the most poorly understood complication of ileal reservoir surgery. Variability in definition of this syndrome may account for differences in incidence rate, associated symptoms, and response rate to therapy present in the literature. Outcomes of 19 episodes of pouch ileitis in patients having undergone prior colectomy and continent ileostomy construction for presumed ulcerative colitis were analyzed. An episode of pouch ileitis was characterized by: (1) abdominal pain, (2) increased ileal output, (3) mucosal inflammation within the continent ileostomy, and (4) absence of other recognized concurrent postoperative complications. The mean time of occurrence after construction of the continent ileostomy was 25 months (range 3–54 months). The mean length of follow-up of patients included in this analysis was 49 months from the time of continent ileostomy construction (range 22–101 months). Associated clinical symptoms included bloody effluent (53%), nausea or emesis (47%), and fever (42%). Endoscopic features were often nonspecific, with mucosal erythema (84%), edema (79%), friability (58%), and mucosal ulceration (53%) the most common. In those episodes of pouch ileitis where ileoscopy revealed no evidence of mucosal ulceration, complete resolution of the episode occurred 89% of the time, with 78% treated with antibiotics alone. In those episodes where mucosal ulceration was described on ileoscopy, 40% of episodes completely resolved after medical treatment, 20% with antibiotics alone. The varied clinical symptoms, endoscopic findings, and response to treatment raises the possibility that what has previously been described in the literature as pouch ileitis may be a heterogeneous group not of single etiology. This concept is consistent with the existing literature supporting both bacterial overgrowth and recurrence of inflammatory bowel disease as etiologies of pouch dysfunction and ileitis.
Similar content being viewed by others
References
Fazio VW, Church JM: Complications and function of the continent ileostomy at the Cleveland Clinic. World J Surg 12:148–154, 1988
Bonello JC, Thow GB, Manson RR: Mucosal enteritis: A complication of the continent ileostomy. Dis Colon Rectum 24:37–41, 1981
Gerber M, Apt MK, Craig PH: The improved quality of life with the Kock continent ileostomy. J Clin Gastroenterol 6:513–517, 1984
McLeod RS, Fazio VW: The continent ileostomy.In Mucosal Ulcerative Colitis. DG Jagelman (ed). Mount Kisco, New York, Futura Publishing, 1986
Fleshman JW, Cohen Z, McLeod RS, et al: The ileal reservoir and ileoanal anastomosis procedure. Dis Colon Rectum 31:10–16, 1988
Schrock TR: Complications of continent ileostomy. Am J Surg 138:162–169, 1979
Pemberton JH, Kelly KA, Beart RW, et al: Ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg 206(4):504–513, 1987
Halvorsen JF, Heimann P, Hoel R, Nygaard K: The continent reservoir ileostomy: Review of a collective series of thirty-six patients from three surgical departments. Surgery 83(3):252–258, 1978
Cohen Z: Current status of the continent ileostomy. Can J Surg 30(5):357–358, 1987
Gerber A, Apt MK, Craig PH: The Kock continent ileostomy. Surg Gynecol Obstet 156:345–349, 1983
Kock NG: Present status of the continent ileostomy: Surgical revision of the malfunctioning ileostomy. Dis Colon Rectum 19(3):200–206, 1976
Kock NG, Myrvold HE, Nilsson LO, Philipson BM: Continent ileostomy: The Swedish experience.In Alternatives to Conventional Ileostomy. RR Dozois (ed). Year Book Medical Publishers, Chicago, 1985, p 163
Dozois RR, Kelly KA, Beart RW, Beahrs OH: Continent Ileostomy: The Mayo Clinic experience.In Alternatives to Conventional Ileostomy. RR Dozios (ed). Year Book Medical Publishers, Chicago, 1985, p 180
Church JM, Fazio VW, Lavery IC. The role of fiberoptic endoscopy in the management of the continent ileostomy. Gastrointest Endosc 33(3):203, 1987
Brandberg A, Kock NG, Philipson B: Bacterial flora in intra-abdominal ileostomy reservoir. Gastroenterology 63(3):413–416, 1972
Loeschke K, Bolkert T, Kiefhaver P, et al: Bacterial overgrowth in ileal reservoirs (Kock pouch): Extended functional studies. Hepato-Gastroenterology 27:310–316, 1980
Schjonsby H, Halvorsen JF, Hofstad T, Hovdenak N: Stagnant loop syndrome in patients with continent ileostomy (intra-abdominal ileal reservoir) Gut 18:795–799, 1977
Kelly DG, Branon ML, Phillips SF, Kelly KA: Diarrhoea after continent ileostomy. Gut 21:711–716, 1980
Kelly DG, Phillips SF, Kelly KA, et al: Dysfunction of the continent ileostomy: Clinical features and bacteriology. Gut 24:193–201, 1983
O'Connell PR, Rankin DR, Weiland LH, Kelly KA: Enteric bacteriology, absorption, morphology and emptying after ileal pouch-anal anastomosis. Br J Surg 73:909–914, 1986
Heppell J, Belliveau P, Taillefer R, et al: Quantitative assessment of pelvic ileal reservoir emptying with a semisolid radionuclide enema. Dis Colon Rectum 30:81–85, 1987
Gustavsson S, Weiland LH, Kelly KA: Relationship of backwash ileitis to ileal pouchitis after ileal pouch-anal anastomosis. Dis Colon Rectum 30:25–28, 1987
Klein K, Stenzel P, Katon RM: Pouch ileitis: Report of a case with severe systemic manifestations. J Clin Gastroenterol 5:149–153, 1983
Knobler H, Ligumsky M, Okon E, et al: Pouch ileitis—recurrence of the inflammatory bowel disease in the ileal reservoir. Am J Gastroenterol 81:199–201, 1986
Philipson B, Brandberg A, Jagenburg R, et al: Mucosal morphology, bacteriology, and absorption in intraabdominal ileostomy reservoir. Scand J Gastroenterol 10:145–153, 1975
Nilsson LO, Kock NG, Lindgren L, et al: Morphological and histochemical changes in the mucosa of the continent ileostomy reservoir 6–10 years after its construction. Scand J Gastroenterol 15:737–747, 1980
Go PMNYH Lens J, Bosman IT: Mucosal alterations in the reservoir of patients with Kock's continent ileostomy. Scand J Gastroenterol 22:1076–1080, 1987
Nicholls RJ, Belliveau P, Neill M, et al: Restorative proctocolectomy with ileal reservoir: A pathophysiological assessment. Gut 22:462–468, 1981
Shepherd NA, Jass JR, Duval I, et al: Restorative protocolectomy with ileal reservoir: Pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol 40:601–607, 1987
Moskowitz RL, Shepherd NA, Nicholls RJ: An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorect Dis 1:167–174, 1986
Turnbull RB, Weakley FL, Farmer RG: Ileitis after colectomy and ileostomy for nonspecific ulcerative colitis: Report of 35 cases. Dis Colon Rectum 7:427–435, 1964
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Zuccaro, G., Fazio, V.W., Church, J.M. et al. Pouch ileitis. Digest Dis Sci 34, 1505–1510 (1989). https://doi.org/10.1007/BF01537101
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01537101