Abstract
Aim
The study aim is to review the prevalence, management, and outcomes for patients diagnosed with ileal pouch prolapse after restorative proctocolectomy.
Materials and Methods
Patients were identified retrospectively from a prospectively maintained pouch database. Parameters analyzed included presenting symptoms, indications for pouch surgery, type of ileal pouch-anal anastomosis, treatment modalities, and outcomes.
Results
Of 3,176 patients who underwent ileal pouch surgery, 11 were diagnosed with pouch prolapse (0.3%). Seven had full-thickness prolapse and four mucosal prolapse. Six were male, and five were female. Indication for index surgery was ulcerative colitis (nine patients), familial adenomatous polyposis (one patient), and colonic inertia (one patient). Median age at pouch prolapse was 34 years. Median time from index surgery to prolapse diagnosis was 2 years. Two patients with mucosal prolapse responded to conservative management; two required mucosal excisions. An abdominal approach was successful in four out of seven patients with full thickness prolapse. The three failures subsequently underwent continent ileostomy formation and prompted us to add biological mesh to future pouchpexy repairs.
Conclusions
Pouch prolapse is rare, and there are no obvious predisposing factors. Mucosal prolapse may be treated by stool bulking or a local perineal procedure. Full thickness prolapse requires definitive surgery and is associated with risk of pouch loss.
Similar content being viewed by others
References
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 1978;2:85–88.
Michelassi F, Lee J, Rubin M, Fichera A, Kasza K, Karrison T, Hurst RD. Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: a prospective observational study. Ann Surg 2003;238:433–441. discussion 442-445.
Fazio VW, Ziv Y, Church JM, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 1995;222:120–127.
Shen B, Remzi FH, Lavery IC, Lashner BA, Fazio V. A proposed classification of ileal pouch disorders and associated complications after restorative proctocolectomy. Clinical gastroenterology and hepatology 2008;6:145–158.
Melton GB, Fazio VW, Kiran RP, et al. Long-term outcomes with ileal pouch-anal anastomosis and Crohn’s disease. Pouch retention and implications of delayed diagnosis. Ann Surg 2008;248:608–616.
Remzi FH, Fazio VW, Oncel M, et al. Portal vein thrombi after restorative proctocolectomy. Surgery 2002;132:612–655.
Ehsan M, Isler JT, Kimmins MH, Billingham RP. Prevalence and management of prolapse of the ileoanal pouch. Dis Colon Rectum 2004;47:885–888.
Remzi FH, Fazio VW, Kirat HT, et al. Repeat pouch surgery by the abdominal approach safely salvages failed ileal pelvic pouch. Dis Colon Rectum 2009;52:198–204.
Funayama Y, Fukushima K, Shibata C, et al. Transabdominal repair of prolapsed pelvic ileal J-pouch after restorative proctocolectomy. In J Colorectal Dis 2005;20:553–554.
Author information
Authors and Affiliations
Corresponding author
Additional information
Some data pertaining to this article was presented in poster format, American Society of Colon and Rectal Surgeon, St Louis, June 2–6, 2007.
Rights and permissions
About this article
Cite this article
Joyce, M.R., Fazio, V.W., Hull, T.T. et al. Ileal Pouch Prolapse: Prevalence, Management, and Outcomes. J Gastrointest Surg 14, 993–997 (2010). https://doi.org/10.1007/s11605-010-1194-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-010-1194-y