Abstract
A patient with an 18-year history of ulcerative colitis was operated on with colectomy, mucosal proctectomy, ileoanal anastomosis, and an S-type pelvic pouch due to intractable chronic continuous disease. The patient was followed by endoscopic controls and biopsy sampling from the pouch at regular intervals. A gradual development of severe atrophy in the ileal mucosa was followed by the development of low grade dysplasia. At the most recent endoscopic control, 4 years after the construction of the pouch, biopsies were sampled also for flow cytometric DNA analyses. DNA aneuploidy was detected in a biopsy from the center of the pouch, and a biopsy taken immediately adjacent showed low grade dysplasia. These findings underline the importance of endoscopic follow-up after construction of a pelvic pouch and focus attention to the potential of malignant transformation of the mucosa.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 1978;2:85–8.
Utsunomiya J, Iwama T, Imajo M, Matsuo S, Sawai S, Yaegashi K, Hirayama R. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 1980;23:459–66.
Pemberton JH, Kelly KA, Beart RW Jr, Dozois RR, Wolff BG, Ilstrup DM. Ileal pouch-anal anastomosis for chronic ulcerative colitis: long-term results. Ann Surg 1987;206:504–13.
Vasilevsky C-A, Rothenberger DA, Goldberg SM. The ileal pouch-anal anastomosis. World J Surg 1987; 11:742–50.
Fonkalsrud EW, Stelzner M, McDonald N. Experience with the endorectal ileal pullthrough with lateral reservoir for ulcerative colitis and polyposis. Arch Surg 1988;123:1053–8.
Lindquist K. The pelvic pouch: studies on surgical development, functional outcome, pouch evacuation, sphincter manometry, and mucosal adaptation. Thesis, Karolinska Institute, Stockholm, 1989.
Smart PJ, Sastry S, Wells S. Primary mucinous adenocarcinoma developing in an ileostomy stoma. Gut 1988;29:1607–12.
Berman JJ, Ullah A. Colonic metaplasia of ileostomies: biological significance for ulcerative colitis patients following total colectomy. Am J Surg Pathol 1989;13:955–60.
Veress B, Reinholt FP, Lindquist K, Liljequist L. Different types of mucosal adaptation in the ileal reservoir after restorative proctocolectomy: a two-year follow-up study. APMIS 1990 (in press).
Riddell RH, Goldman H, Ransohoff D,et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol 1983;14:931–66.
Reinholt FP, Veress B, Lindquist K, Liljeqvist L. Qualitative assessment and morphometry in the study of the ileal reservoir after restorative proctocolectomy. APMIS 1989;97:97–104.
Löfberg R, Tribukait B, Öst Å, Broström O, Reichard H. Flow cytometric DNA analysis in long-standing ulcerative colitis: a method of prediction of dysplasia and carcinoma development? Gut 1987;28:1100–6.
Melville DM, Jass JR, Shepherd NA,et al. Dysplasia and deoxyribonucleic acid aneuploidy in the assessment of precancerous changes in chronic ulcerative colitis: observer variations and correlations. Gastroenterology 1988;95:668–75.
Öjerskog B, Kock NG, Nilsson LO, Philipson BM, Åhrén C. Long-term follow-up of patients with continent ileostomies. Dis Colon Rectum 1990;33:184–9.
Nasmyth DG, Godwin PGR, Dixon MF, Williams NS, Johnston D. The relationship between mucosal structure and intestinal flora in ileal reservoirs. Br J Surg 1985;72(suppl):129.
Author information
Authors and Affiliations
About this article
Cite this article
Löfberg, R., Liljeqvist, L., Lindquist, K. et al. Dysplasia and DNA aneuploidy in a pelvic pouch. Dis Colon Rectum 34, 280–284 (1991). https://doi.org/10.1007/BF02090171
Issue Date:
DOI: https://doi.org/10.1007/BF02090171