Advertisement

Ileoanal Pouches and Indeterminate Colitis

  • Gilberto Poggioli
  • Silvio Laureti
  • Filippo Pierangeli
  • Federica Ugolini
  • Maurizio Coscia
  • Lorenzo Gentilini
  • Piero Bazzi

Conclusions

Correct diagnosis of IC has become essential in the “pouch era” for the good outcome of patients submitted to IPAA.

Patients with IC have an increased risk of emergency colectomy. It is still not clear whether this is related to a more aggressive natural history of IC or if the certain diagnosis of IC is more difficult in case of emergency colectomy.

From the practical point of view, one of the most important issues is represented by diagnosis of IC in the surgical specimen; the pathologists should provide a “likelihood” diagnosis in order to help the surgeon’s decision-making process. Moreover, this “likelihood” diagnosis is confirmed in many papers by the long-term follow-up in many series.

Late complications of IPAA are represented mainly by small-bowel stenosis or fistula and pouch-anal or pouch-vaginal fistulae. Only the first are pathognomonic of mislead CD while the occurrence of anal fistulae not necessarily indicate evolution to CD.

Keywords

Ulcerative Colitis Ulcerative Colitis Patient Ileal Pouch Pelvic Sepsis Indeterminate Colitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kent Th, Ammon Rk, Den Besten L (1970) Differentiation of ulcerative colitis and regional enteritis. Arch Pathol 89:20–29PubMedGoogle Scholar
  2. 2.
    Morson BC (1974) Colitis unclassified. In: Morson BC, Dawson IMP (eds) Gastrointestinal pathology. Blackwell, Oxford, pp 485–486Google Scholar
  3. 3.
    Geboes K, De Hertogh G (2003) Indeterminate colitis. Inflamm Bowel Dis 9:324–331PubMedCrossRefGoogle Scholar
  4. 4.
    Hildebrand H, Brydolf M, Holmquist L et al (1994) Incidence and prevalence of IBD in children in South Western Sweden. Acta Pediatr 83:640–645Google Scholar
  5. 5.
    Moum B, Vatn MH, Ekbom A et al (1996) Incidence of Ulcerative Colitis and indeterminate colitis in four counties of South Western Norway. 1990–93: a prospective population-based study. Scand J Gastroenterol 31:362–366PubMedGoogle Scholar
  6. 6.
    Meucci G, Bortoli A, Riccioli FA et al (1999) Frequency and clinical evolution of indeterminate colitis: a retrospective multicenter study in Northern Italy. Eur J Gastroenterol Hepatol 11:909–913PubMedCrossRefGoogle Scholar
  7. 7.
    Joossens S, Reinish W, Vermeire S et al (2002) The value of anti-saccharomyces cerevisiae antibodies (ASCA) and perinuclear anti-neutrophil cytoplasmic antibodies in indeterminate colitis: a prospective follow-up study. Gastroentrology 122:1242–1247CrossRefGoogle Scholar
  8. 8.
    Wells Ad, Mcmillan I, Price Ab et al (1991) Natural history of indeterminate colitis. Br J Surg 78:179–181PubMedGoogle Scholar
  9. 9.
    Stewenius J, Adnerhill I, Ekelund G et al (1995) Ulcerative colitis and indeterminate colitis in the city of Malmo, Sweden. A 25-year incidence study. Scand J Gastroenterol 30(1):38–43PubMedGoogle Scholar
  10. 10.
    Burakoff R (2004) Indeterminate colitis: clinical spectrum of disease. J Clin Gastroenterol 38(Suppl 5):41–43CrossRefGoogle Scholar
  11. 11.
    Price AB (1978) Overlap in the spectrum of non-specific inflammatory bowel diseases — “colitis indeterminate”. J Clin Pathol 31:567–577PubMedGoogle Scholar
  12. 12.
    Lee KS, Medline A, Shockey S et al (1979) Indeterminate colitis in the spectrum of inflammatory bowel disease. Arch Pathol Lab Med 103:173–176PubMedGoogle Scholar
  13. 13.
    Odze R (2003) Diagnostic problems and advances in inflammatory bowel disease. Mod Pathol 16:347–358PubMedCrossRefGoogle Scholar
  14. 14.
    Yantiss RK, Farraye FA, O’Brien MJ et al (2006) Prognostic significance of superficial fissuring ulceration in patients with severe “indeterminate” colitis. Am J Surg Pathol 30:165–170PubMedCrossRefGoogle Scholar
  15. 15.
    Robert ME, Skacel M, Ullman T et al (2004) Patterns of colonic involvement at initial presentation in ulcerative colitis: a retrospective study of 46 newly diagnosed cases. Am J Clin Pathol 122(1):94–99PubMedCrossRefGoogle Scholar
  16. 16.
    Washington K, Greenson JK, Montgomery E et al (2002) Histopathology of Ulcerative COlitis in initial rectal biopsy in children. Am J Surg Pathos 26:1441–1449CrossRefGoogle Scholar
  17. 17.
    Tang LH, Reyes-Mugica M, Hao L et al (2000) Histologic difference between children and adults presenting with ulcerative colitis. Mod Pathol 14:96AGoogle Scholar
  18. 18.
    Ekbom A (2000) Indeterminate IBD: the magnitude of the problem. Inflamm Bowel Dis 6:S14–S15Google Scholar
  19. 19.
    Quinton JF, Sendid B, Reumaux D et al (1998) Antisaccharomyces cerevisiae mannan antibodies combined with anti-neutrophil cytoplasmic auto-antibodies in inflammatory bowel disease: prevalence and diagnostic role. Gut 42:788–791PubMedCrossRefGoogle Scholar
  20. 20.
    Zachos M, Reumaux D, Critch J et al (2001) utility of ASCA and ANCA in pediatric colitis. J Pediatr Gastroenterol Nutr 33:378–381Google Scholar
  21. 21.
    Peeters M, Joossens S, Vermeire S et al (2001) Diagnostic value of anti-saccharomyces cerevisiae and anti-neutrophil cytoplasmic antibodies in inflammatory bowel disease. Am J Gastroenterol 96:730–734PubMedCrossRefGoogle Scholar
  22. 22.
    Hui T, Landers C, Vasiliauskas E et al (2005) Serologic responses in indeterminate colitis patients before ileal pouch-anal anastomosis may determine those at risk for continuous pouch inflammation. Dis Colon Rectum 48:1254–1262PubMedCrossRefGoogle Scholar
  23. 23.
    Bezabeh T, Somoryai RL, Smith IC et al (2001) The use of 1 H magnetic resonance spectroscopy in inflammatory bowel diseases: distinguishing ulcerative colitis from Crohn’s disease. Am J Gastroenterol 96:442–448PubMedCrossRefGoogle Scholar
  24. 24.
    Costamagna G, Shah SK, Riccioni ME et al (2002) A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterol 123:999–1005CrossRefGoogle Scholar
  25. 25.
    Mow WS, LO SK, Targan SR et al (2004) Initial experience with wireless capsule enteroscopy in the diagnosis and management of inflammatory bowel disease. Clin Gastroenterol Hepathol 2:31–40CrossRefGoogle Scholar
  26. 26.
    Black APB, Bhayani H, Ryder CAJ et al (2004) Infliximab in the treatment of medically refractory indeterminate colitis. Aliment Pharmacol Ther 18:741–748Google Scholar
  27. 27.
    Panis Y, Poupard B, Nemeth J et al (1996) Ileal pouch/anal anastomosis for Crohn’s disease. Lancet 347:854–857PubMedCrossRefGoogle Scholar
  28. 28.
    Deutsch AA, Mc Leod RS, Cullen J et al (1991) Results of the pelvic pouch procedure in patients with Crohn’s disease. Dis Colon Rectum 34:475–477PubMedCrossRefGoogle Scholar
  29. 29.
    Sagar PM, Dozois RR, Wolff BG (1996) Long-term results of ileal pouch-anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 39:893–898PubMedCrossRefGoogle Scholar
  30. 30.
    Hyman NH, Fazio VW, Tuckson WB et al (1991) Consequences of ileal pouch-anal anastomosis for Crohn’s Disease. Dis Colon Rectum 34:653–657PubMedCrossRefGoogle Scholar
  31. 31.
    Keighley MR (2000) The final diagnosis in pouch patients for presumed Ulcerative Colitis may change to Crohn’s disease: patients should be warned of the consequences. Acta Chir Jugosl 47:27–31Google Scholar
  32. 32.
    Mylonakis E, Allan RN, Keighley MR (2001) How does pouch construction for a final diagnosis of Crohn’s disease compare with ileoproctostomy for established Crohn’s proctocolitis? Dis Colon Rectum 44(8):1137–1142; discussion 1142–1143PubMedCrossRefGoogle Scholar
  33. 33.
    Brown CJ, MacLean AR, Cohen Z et al (2005) Crohn’s disease and indeterminate colitis and the ileal pouchanal anastomosis: outcome and patterns of failure. Dis Colon Rectum 48:1542–1549PubMedCrossRefGoogle Scholar
  34. 34.
    Fazio VW, Wu JS, Lavery IC (1998) Repeat ileal pouchanal anastomosis to salvage septic complications of pelvic pouches: clinical outcome and quality of life assessment. Ann Surg 228:588–597PubMedCrossRefGoogle Scholar
  35. 35.
    Marcello P, Schoetz DJ Jr, Roberts PL et al (1997) Evolutionary changes in the pathologic diagnosis after the ileoanal pouch procedure. Dis Colon Rectum 40:263–269PubMedCrossRefGoogle Scholar
  36. 36.
    Koltun WA, Schoetz DJ Jr, Roberts PL et al (1991) Indeterminate colitis predisposes to perineal complications after ileal pouch-anal anastomosis. Dis Colon Rectum 34:857–860PubMedCrossRefGoogle Scholar
  37. 37.
    Mc Intyre PB, Pemberton JH, Wolff BG et al (1995) Indeterminate colitis: long-term in patients after ileal pouch-anal anastomosis. Dis Colon Rectum 38:51–54CrossRefGoogle Scholar
  38. 38.
    Atkinson KG, Owen DA, Wankling G (1994) Restorative proctocolectomy and indeterminate colitis. Am J Surg 167:516–518PubMedCrossRefGoogle Scholar
  39. 39.
    Grobler SP, Hosie KB, Affie E et al (1993) Outcome of restorative proctocolectomy when the diagnosis is suggestive of Crohn’s disease. Gut 34(10):1384–1388PubMedGoogle Scholar
  40. 40.
    Gramlich T, Delaney CP, Lynch AC et al (2003) Pathological subgroups may predict complications but not late failure after ileal pouch-anal anastomosis for indeterminate colitis. Colorectal Dis 5:315–319PubMedCrossRefGoogle Scholar
  41. 41.
    Dayton MT, Larsen KR, Christiansen DD (2002) Similar functional results and complications after ileal pouch-anal anastomosis in patients with indeterminate vs ulcerative colitis. Arch Surg 137:690–695PubMedCrossRefGoogle Scholar
  42. 42.
    Rudolph WG, Uthoff SMS, McAuliffe TL et al (2002) Indeterminate colitis: the real story. Dis Colon Rectum 45:1528–1534PubMedCrossRefGoogle Scholar
  43. 43.
    Pishori T, Dinnewitzer A, Zmora O et al (2004) Outcome of patients with indeterminate colitis undergoing a double-stapled ileal pouch-anal anastomosis. Dis Colon Rectum 47:717–721PubMedCrossRefGoogle Scholar
  44. 44.
    Yu CS, Pemberton JH, Larson MS (1999) Ileal pouchanal anastomosis in patients with indeterminate colitis: long-term results. Oral Presentation at the 85th ACS Clinical Congress, San Francisco, CAGoogle Scholar
  45. 45.
    Richard CS, Cohen Z, Stern HS et al (1997) Outcome of the pelvic pouch procedure in patients with prior perianal disease. Dis Colon Rectum 40:647–652PubMedCrossRefGoogle Scholar
  46. 46.
    Tekkis PP, Heriot AG, Smith O et al (2005) Long-term outcomes of restorative proctocolectomy for Crohn’s disease and indeterminate colitis. Colorectal Dis 7:218–223PubMedCrossRefGoogle Scholar
  47. 47.
    Colombel JF, Ricart E, Loftus EV et al (2003) Management of Crohn’s disease of the ileo-anal pouch with Infliximab. Am J Gastroenterol 98:2239–2244PubMedCrossRefGoogle Scholar
  48. 48.
    Ozuner G, Hull T, Lee P et al (1997) What happens to a pelvic pouch when a fistula develops? Dis Colon Rectum 40:543–547PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2006

Authors and Affiliations

  • Gilberto Poggioli
    • 1
  • Silvio Laureti
    • 1
  • Filippo Pierangeli
    • 1
  • Federica Ugolini
    • 1
  • Maurizio Coscia
    • 1
  • Lorenzo Gentilini
    • 1
  • Piero Bazzi
    • 1
  1. 1.Unit of General Surgery Policlinico S. Orsola-MalpighiUniversity of BolognaBolognaItaly

Personalised recommendations