Abstract
Ileal pouch surgery is the surgical gold standard treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). However, ileal pouch surgery is a technically challenging procedure and is associated with high morbidity. Clinical presentations of pouch complications are often nonspecific but imaging can identify many of these complications and is essential in clinical management. This paper will focus on magnetic resonance imaging (MRI) of the ileal pouch, including recommended MRI protocol and approach to imaging interpretation with an emphasis on those ileal pouch complications particularly well evaluated with MRI.
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Quinn KP, Lightner AL, Faubion WA, Raffals LE. A Comprehensive Approach to Pouch Disorders. Inflammatory Bowel Diseases 2018; 25:460-471
Baker ME, Hull T, Holubar S, Lightner A, Qazi T. Clinical issues facing pouch patients: an introduction to a special issue on the ileal pouch. Abdominal Radiology https://doi.org/10.1007/s00261-022-03723-x
Ream J, Luk L, Sheedy S, Fletcher JG, Church JM, Baker ME (2022). Dynamic pouch emptying studies. (Submitted).
Reber JD, Barlow JM, Lightner AL, et al. J Pouch: Imaging Findings, Surgical Variations, Natural History, and Common Complications. Radiographics 2018:170113
Guyton K, Kearney D, Holubar SD. Anastomotic Leak after Ileal Pouch-Anal Anastomosis. Clinics in colon and rectal surgery 2021; 34:417-425
VanBuren WM, Lightner AL, Kim ST, et al. Imaging and Surgical Management of Anorectal Vaginal Fistulas. Radiographics 2018; 38:1385-1401
Huang C, Remzi FH, Dane B, et al. Reporting Templates for MRI and Water-Soluble Contrast Enema in Patients With Ileal Pouch-Anal Anastomosis: Experience From a Large Referral Center. AJR Am J Roentgenol 2021; 217:347-358
Sheedy SP, Bartlett DJ, Lightner AL, et al. Judging the J pouch: a pictorial review. Abdominal radiology (New York) 2019; 44:845-866
Fazio VW, Kiran RP, Remzi FH, et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 2013; 257:679-685
Lovegrove RE, Constantinides VA, Heriot AG, et al. A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg 2006; 244:18-26
Aydinli HH, Peirce C, Aytac E, Remzi F. The usefulness of the H-pouch configuration in salvage surgery for failed ileal pouches. Colorectal Dis 2017; 19:e312-e315
Sherman J, Greenstein AJ, Greenstein AJ. Ileal j pouch complications and surgical solutions: a review. Inflamm Bowel Dis 2014; 20:1678-1685
Kirat HT, Kiran RP, Oncel M, Shen B, Fazio VW, Remzi FH. Management of leak from the tip of the "J" in ileal pouch-anal anastomosis. Dis Colon Rectum 2011; 54:454-459
Dwarkasing S, Hussain SM, Hop WC, Krestin GP. Anovaginal fistulas: evaluation with endoanal MR imaging. Radiology 2004; 231:123-128
Hyde BJ, Byrnes JN, Occhino JA, Sheedy SP, VanBuren WM. MRI review of female pelvic fistulizing disease. J Magn Reson Imaging 2018; 48:1172-1184
Mallick IH, Hull TL, Remzi FH, Kiran RP. Management and outcome of pouch-vaginal fistulas after IPAA surgery. Dis Colon Rectum 2014; 57:490-496
Tsujinaka S, Ruiz D, Wexner SD, et al. Surgical management of pouch-vaginal fistula after restorative proctocolectomy. Journal of the American College of Surgeons 2006; 202:912-918
Heriot AG, Tekkis PP, Smith JJ, Bona R, Cohen RG, Nicholls RJ. Management and outcome of pouch-vaginal fistulas following restorative proctocolectomy. Dis Colon Rectum 2005; 48:451-458
Johnson PM, O'Connor BI, Cohen Z, McLeod RS. Pouch-vaginal fistula after ileal pouch-anal anastomosis: treatment and outcomes. Diseases of the colon and rectum 2005; 48:1249-1253
Shah NS, Remzi F, Massmann A, Baixauli J, Fazio VW. Management and treatment outcome of pouch-vaginal fistulas following restorative proctocolectomy. Dis Colon Rectum 2003; 46:911-917
Wu B, Lian L, Li Y, et al. Clinical course of cuffitis in ulcerative colitis patients with restorative proctocolectomy and ileal pouch-anal anastomoses. Inflamm Bowel Dis 2013; 19:404-410
Fenger C. The anal transitional zone. Acta pathologica, microbiologica, et immunologica Scandinavica Supplement 1987; 289:1-42
Shen B, Lashner BA, Bennett AE, et al. Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. Am J Gastroenterol 2004; 99:1527-1531
Huang C, Remzi FH, Dane B, et al. Reporting Templates for MRI and Water-Soluble Contrast Enema in Patients With Ileal Pouch-Anal Anastomosis: Experience From a Large Referral Center. Am J Roentgenol 2020; 217:347-358
Holubar S, Lightner A, Qazi T, et al. TWISTED POUCH SYNDROME-A DIFFICULT TO DIAGNOSE MECHANICAL COMPLICATION OF ILEAL POUCH-ANAL ANASTOMOSIS: OUTCOMES AFTER REDO POUCH PROCEDURES. Inflammatory Bowel Diseases 2021; 27:S16-S17
Dionigi B, Prien C, Lavryk O, Lightner AL, Holubar SD, Hull T. Pouch volvulus-why adhesions are not always the enemy. Colorectal Dis 2022; 24:1192-1196
Landisch RM, Knechtges PM, Otterson MF, Ludwig KA, Ridolfi TJ. Pouch Volvulus in Patients Having Undergone Restorative Proctocolectomy for Ulcerative Colitis: A Case Series. Dis Colon Rectum 2018; 61:713-718
Abbass MA, Lavryk OA, Hyman N, Liska D, Kalady MF, Church J. Nonspecific, Acute Pouchitis in Patients With Familial Adenomatous Polyposis: Less Common Than We Think. Dis Colon Rectum 2022; 65:846-850
Zezos P, Saibil F. Inflammatory pouch disease: The spectrum of pouchitis. World journal of gastroenterology 2015; 21:8739-8752
Shen B, Achkar JP, Connor JT, et al. Modified pouchitis disease activity index: a simplified approach to the diagnosis of pouchitis. Dis Colon Rectum 2003; 46:748-753
Ruseler-van Embden J, Schouten W, Van Lieshout L. Pouchitis: result of microbial imbalance? Gut 1994; 35:658-664
Sandborn WJ. Pouchitis following heal pouch-anal anastomosis: definition, pathogenesis, and treatment. Gastroenterology 1994; 107:1856-1860
Quinn KP, Lightner AL, Faubion WA, Raffals LE. A Comprehensive Approach to Pouch Disorders. Inflamm Bowel Dis 2019; 25:460-471
Broder JC, Tkacz JN, Anderson SW, Soto JA, Gupta A. Ileal pouch-anal anastomosis surgery: imaging and intervention for post-operative complications. Radiographics 2010; 30:221-233
Shen B. Problems after restorative proctocolectomy: assessment and therapy. Curr Opin Gastroenterol 2016; 32:49-54
Lightner AL, Fletcher JG, Pemberton JH, Mathis KL, Raffals LE, Smyrk T. Crohn's Disease of the Pouch: A True Diagnosis or an Oversubscribed Diagnosis of Exclusion? Dis Colon Rectum 2017; 60:1201-1208
Lightner AL, Pemberton JH, Loftus EJ, Jr. Crohn's Disease of the Ileoanal Pouch. Inflamm Bowel Dis 2016; 22:1502-1508
Shen B. Crohn's disease of the ileal pouch: reality, diagnosis, and management. Inflamm Bowel Dis 2009; 15:284-294
Shen B, Bennett AE, Navaneethan U, et al. Primary sclerosing cholangitis is associated with endoscopic and histologic inflammation of the distal afferent limb in patients with ileal pouch-anal anastomosis. Inflamm Bowel Dis 2011; 17:1890-1900
Shen B, Kochhar GS, Kariv R, et al. Diagnosis and classification of ileal pouch disorders: consensus guidelines from the International Ileal Pouch Consortium. Lancet Gastroenterol Hepatol 2021; 6:826-849
Prudhomme M, Dozois RR, Godlewski G, Mathison S, Fabbro-Peray P. Anal canal strictures after ileal pouch-anal anastomosis. Dis Colon Rectum 2003; 46:20-23
Wu XR, Kiran RP, Mukewar S, Remzi FH, Shen B. Diagnosis and management of pouch outlet obstruction caused by common anatomical problems after restorative proctocolectomy. J Crohns Colitis 2014; 8:270-275
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CH: None. BD: Speaker honorarium from Siemens Healthineers. CS: Consultant—Alimentiv Clinical Research. Consultant—Clario Clinical Research. JR: None.
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Huang, C., Dane, B., Santillan, C. et al. MRI of the ileal pouch. Abdom Radiol 48, 2944–2955 (2023). https://doi.org/10.1007/s00261-023-03803-6
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DOI: https://doi.org/10.1007/s00261-023-03803-6