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Surgery for pouch inflow limb–related complications: Crohn’s disease or something else?

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International Journal of Colorectal Disease Aims and scope Submit manuscript



A total proctocolectomy with subsequent creation of an ileal-pouch, such as a J-pouch or a Kock pouch, has been the most common surgery performed for ulcerative colitis (UC). A small portion of these patients will develop complications with the inflow limb into the pouch requiring operative intervention. The objective was to establish a better understanding as to the pathological mechanism by which these pouch inflow limb problems develop.


This was a retrospective cohort study conducted at a single tertiary care inflammatory bowel disease (IBD) center. A database was created of all the patients who underwent pouch-related procedures, following completion of their original pouch, between 2006 and 2018. The patients requiring operative resection for inflow limb complications were identified among this cohort. Operative and pathological data were collected.


One hundred seventy-eight UC patients underwent surgeries on their pouches between 2006 and 2018. Sixteen patients required operative resection for inflow limb problems. Reoperations for inflow limb problems included inflow limb resection with pouch excision (n = 4) and inflow limb resection with pouch revision (n = 12). The pathology findings of the inflow limb were consistent with Crohn’s disease in 9 patients (56%). Two other patients (total 69%) were eventually diagnosed with Crohn’s disease due to other pathological specimens or perianal pathology. The remaining patients had chronic, non-specific enteritis/serositis.


A small proportion of pouch patients will eventually require surgery for inflow limb complications. Among these, there was a high rate of Crohn’s disease of the inflow limb and overall change in diagnosis to Crohn’s disease (Plietz et al. in Official Journal of the American College of Gastroenterology | ACG 114:S453, 2019).

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Correspondence to Michael C. Plietz.

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Poster Presentation: American College of Gastroenterology 2019; San Antonio, TX; October 25–30, 2019

One abstract published in American Journal of Gastroenterology in October 2019

What does this paper add to the literature?

This study reviewed the pathologic surgical specimens of post-pouch ulcerative colitis patients who underwent resection of their inflow limb due to complications. The patients in this study were found to have a high rate of histopathological Crohn’s disease of the inflow limb and overall change in diagnosis to Crohn’s disease.

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Plietz, M.C., Mui, A., Kayal, M. et al. Surgery for pouch inflow limb–related complications: Crohn’s disease or something else?. Int J Colorectal Dis 37, 879–885 (2022).

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