Abdominal Radiology

, Volume 44, Issue 3, pp 845–866 | Cite as

Judging the J pouch: a pictorial review

  • Shannon P. SheedyEmail author
  • David J. Bartlett
  • Amy L. Lightner
  • Steven W. Trenkner
  • David H. Bruining
  • Jeff L. Fidler
  • Wendaline M. VanBuren
  • Christine O. Menias
  • Joshua D. Reber
  • Joel G. Fletcher
Pictorial essay


Restorative total proctocolectomy with ileal pouch-anal anastomosis is the surgery of choice for patients with medically refractory ulcerative colitis, ulcerative colitis with high-grade dysplasia or multi-focal low-grade dysplasia, and for patients with familial adenomatous polyposis. The natural history of the surgery is favorable, and patients generally experience improved quality of life and acceptable long-term functional outcome. However, some patients experience significant long-term morbidity from early and/or late pouch-related complications. When complications arise, radiologists must understand the advantages and disadvantages of the various imaging modalities that can be used to assess the pouch. Radiologist familiarity with the surgical technique, pouch anatomy, and imaging appearance of the various potential early and late complications will help facilitate appropriate clinical and surgical decision-making. This review provides an anatomic-based imaging review of the pouch and pouch-related complications, including numerous illustrative fluoroscopic and cross-sectional imaging examples.


J pouch Ileoanal anastomosis Ileal pouch-anal anastomosis Proctocolectomy Enterography Ulcerative colitis 



The authors acknowledge the assistance of Sonia Watson, PhD, in preparation of the manuscript.

Compliance with ethical standards



Conflict of interest

The authors have no conflicts of interest to declare

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Supplementary material

261_2018_1786_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyMayo ClinicRochesterUSA
  2. 2.Department of Surgery, Division of Colon and Rectal SurgeryMayo ClinicRochesterUSA
  3. 3.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA
  4. 4.Department of RadiologyMayo ClinicScottsdaleUSA

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