• Jacques Heppell
  • Keith A. Kelly


The surgical treatment of ulcerative colitis has evolved considerably over the past few decades. Although proctocolectomy with Brooke ileostomy was the standard operation of the past, surgeons now often employ proctocolectomy with ileal-pouch/anal canal anastomosis. This operation completely excises the diseased mucosa of the large intestine, and yet it preserves transanal defecation and reasonable fecal continence and avoids a permanent ileostomy. These results are achieved because the anal sphincters remain intact to provide fecal continence and because the ileal pouch provides a satisfactory reservoir for feces (1).


Ulcerative Colitis Ileal Pouch Restorative Proctocolectomy Villous Atrophy Ileoanal Anastomosis 
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  1. 1.
    Pemberton JH, Kelly KA, Beart RW, Jr, et al. Ileal pouch anal anastomosis for chronic ulcerative colitis. Long-term results. Ann Surg 1987;206:504–513.PubMedCrossRefGoogle Scholar
  2. 2.
    Kock NG, Darle N, Hulten L, et al. Ileostomy. Curr Probl Surg 1977;14:36–38.CrossRefGoogle Scholar
  3. 3.
    Klein K, Stenzel P, Katon RM, Pouch ileitis: report of a case with severe systemic manifestations. J Clin Gastroenterol 1983;5:149–153.PubMedCrossRefGoogle Scholar
  4. 4.
    Tytgat GNJ, van Deventer SJH. Pouchitis. Int J Colorectal Dis 1988;3:226–228.PubMedCrossRefGoogle Scholar
  5. 5.
    Lohmuller JL, Pemberton JH, Dozois RR, et al. Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouch-anal anastomosis. Ann Surg 1990;211:622–627.PubMedGoogle Scholar
  6. 6.
    Beart RW, Jr. Pouchitis: a clarification (letter). Gastroenterology 1995;109:1022–1023.PubMedCrossRefGoogle Scholar
  7. 7.
    Sandborn WJ. Pouchitis following ileal pouch-anal anastomosis: definition, pathogenesis, and treatment. Gastroenterology 1994;107:1856–1860.PubMedGoogle Scholar
  8. 8.
    Di Febo G, Miglioli M, Lauri A, et al. Endoscopic assessment of acute inflammation of the ileal reservoir after restorative ileo-anal anastomosis. Gastrointest Endosc 1990;36:6–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Church JM, Fazio VW, Lavery IC. The role of fiberoptic endoscopy in the management of the continent ileostomy. Gastrointest Endosc 1987;33:203–209.PubMedCrossRefGoogle Scholar
  10. 10.
    Moskowitz RL, Shepherd NA, Nicholls RJ. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileo-anal ileal reservoir. Int J Colorectal Dis 1986;l:167–174.CrossRefGoogle Scholar
  11. 11.
    Phillips B. Mucosal morphology, bacteriology, and absorption in intra-abdominal ileostomy reservoir. Scand J Gastroenterol 1975;10:145.Google Scholar
  12. 12.
    Shepherd NA, Hulten L, Tytgat GN, et al. Pouchitis. Int J Colorectal Dis 1989;4:205–229.PubMedCrossRefGoogle Scholar
  13. 13.
    Shepherd NA, Jass JR, Duval I, et al. Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol 1987;40:601–607.PubMedCrossRefGoogle Scholar
  14. 14.
    Campbell AP, Merrett MN, Kettlewell M, et al. Expression of colonic antigens by goblet and columnar epithelial cells in ileal pouch mucosa: their association with inflammatory change and fecal stasis. J Clin Path 1994;47:834–838.PubMedCrossRefGoogle Scholar
  15. 15.
    Lerch MM, Braun J, Harder M, et al. Postoperative adaptation of the small intestine after total colectomy and J-pouch-anal anastomosis. Dis Colon Rectum 1989;32:600–608.PubMedCrossRefGoogle Scholar
  16. 16.
    de Silva HJ, Millard PR, Kettlewell M, et al. Mucosal characteristics of pelvic ileal pouches. Gut 1991;32:61–65.PubMedCrossRefGoogle Scholar
  17. 17.
    Apel R, Cohen Z, Andrews CW, et al. Prospective evaluation of early morphological changes in pelvic ileal pouches. Gastroenterology 1994;107:435–443.PubMedGoogle Scholar
  18. 18.
    Heppell J, Kelly KA, Phillips SF, et al. Physiologic aspects of continence after colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis. Ann Surg 1982;195:435–443.PubMedCrossRefGoogle Scholar
  19. 19.
    de Silva HJ, Gatter KC, Millard PR, et al. Crypt cell proliferation and HLA-DR expression in pelvic ileal pouches. J Clin Pathol 1990;43:824–828.PubMedCrossRefGoogle Scholar
  20. 20.
    Warren BF, Shepherd NA. The role of pathology in pelvic ileal reservoir surgery. Int J Colorectal Dis 1992;7:68–75.PubMedCrossRefGoogle Scholar
  21. 21.
    Setti Carrato P, Talbot IC, Nicholls RJ. Longterm appraisal of the histological appearance of the ileal reservoir mucosa after restorative proctocolectomy for ulcerative colitis. Gut 1994;35:1717–1721.Google Scholar
  22. 22.
    Tsao JI, Galandiuk S, Pemberton JH. Pouchogram: predictor of clinical outcomes following ileal-pouch anal anastomosis. Dis Colon Rectum 1992;35:547–551.PubMedCrossRefGoogle Scholar
  23. 23.
    Hagen G, Kolmannskog F, Aesen S, et al. Radiology of the ileal J-pouch-anal anastomosis (IPAA). Acta Radiologica 1993;34:563–568.PubMedCrossRefGoogle Scholar
  24. 24.
    Solomon MJ, McLeod RS, O’Connor BI, et al. Assessment of peripouch inflammation after ileoanal anastomosis using endoluminal ultrasonography. Dis Colon Rectum 1995;38:182–187.PubMedCrossRefGoogle Scholar
  25. 25.
    Kmiot WA, Youngs DJ, Winslet MC, et al. Ileal adaptation following restorative proctocolectomy. Br J Surg 1989;76:625.CrossRefGoogle Scholar
  26. 26.
    Hultén L. Pouchitis-incidence and characteristics in the continent ileostomy. Int J Colorectal Dis 1989; 4:208–210.CrossRefGoogle Scholar
  27. 27.
    Mortensen N. Restorative proctocolecotmy—the pouch operation: good or bad? Scand J Gastroenterol (Suppl) 1992;192:130–135.CrossRefGoogle Scholar
  28. 28.
    Sandborn WJ, Landers CJ, Termaine WJ, et al. Antineutrophil cytoplasmic antibody correlates with chronic pouchitis after ileal pouch-anal anastomosis. Am J Gastroenterol 1995;90:740–747.PubMedGoogle Scholar
  29. 29.
    Sandborn WJ, Tremaine WJ, Batts KP, et al. Pouchitis after ileal pouch-anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc 1994;69:409–415.PubMedCrossRefGoogle Scholar
  30. 30.
    Madden MV, Farthing MJ, Nicholls RJ. Inflammation in ileal reservoirs: ‘pouchitis’. Gut 1990;31:247–249.PubMedCrossRefGoogle Scholar
  31. 31.
    Svaninger G, Nordgren S, Oresland T, et al. Incidence and characteristics of pouchitis in the Kock continent ileostomy and the pelvic pouch. Scand J Gastroenterol 1993;28:695–700.PubMedCrossRefGoogle Scholar
  32. 32.
    Pena JP, Gemlo BT, Rothenberger DA. Ileal pouchanal anastomosis: state of the art. Baillieres Clin Gastroenterol 1992;6:113–127.PubMedCrossRefGoogle Scholar
  33. 33.
    Dozois RR, Kelly KA, Welling DR, et al. Ileal pouchanal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis. Ann Surg 1989;210:268–271.PubMedCrossRefGoogle Scholar
  34. 34.
    Farrands P, Nicholls RJ. Paper presented at the Association of Surgeons of great Britain and Ireland, 1989 quoted by Madden MV, Farthing MJG, Nicholls RJ. Inflammation in ileal reservoirs: “pouchitis.” Gut 1990;31:247–249.CrossRefGoogle Scholar
  35. 35.
    Penna C, Dozois R, Tremaine W, et al. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut 1996;38:234–239.PubMedCrossRefGoogle Scholar
  36. 36.
    Trabucchi E, Doldi SB, Foschi D, et al. Pouch ileitis in excluded reservoir: an unusual complication of restorative proctocolectomy for ulcerative colitis. Int Surg 1988;73:187–189.PubMedGoogle Scholar
  37. 37.
    Gustavsson S, Weiland LH, Kelly KA. Relationship of backwash ileitis to ileal pouchitis after ileal pouchanal anastomosis. Dis Colon Rectum 1987;30:25–28.PubMedCrossRefGoogle Scholar
  38. 38.
    Rauh SM, Schoetz DJ Jr, Roberts PL, et al. Pouchitis—is it a wastebasket diagnosis? Dis Colon Rectum 1991;34:685–689.PubMedCrossRefGoogle Scholar
  39. 39.
    Counsell B. Lesions of the ileum associated with ulcerative colitis. Br J Surg 1956;44:276.PubMedCrossRefGoogle Scholar
  40. 40.
    Scott AD, Phillips RK. Ileitis and pouchitis after colectomy for ulcerative colitis. Br J Surg 1989;76:668–669.PubMedCrossRefGoogle Scholar
  41. 41.
    Kock NG, Myrvold HE, Nilsson LO, et al. Continent ileostomy. An account of 314 patients. Acta Chir Scand 1981;147:67–72.PubMedGoogle Scholar
  42. 42.
    Fleshman JW, Cohen Z, McLeod RS, et al. The ileal reservoir and ileoanal anastomosis procedure. Factors affecting technical and functional outcome. Dis Colon Rectum 1988;31:10–16.PubMedCrossRefGoogle Scholar
  43. 43.
    King DW, Lubowski DZ, Cook TA. Anal canal mucosa in restorative proctocolectomy for ulcerative colitis. Br J Surg 1989;76:970–972.PubMedCrossRefGoogle Scholar
  44. 44.
    Fazio VW, Ziv Y, Church J-M, et al. Ileal pouch-anal anstomoses complications and function in 1005 patients. Ann Surg 1995;222:120–127.PubMedCrossRefGoogle Scholar
  45. 45.
    Lavery IC, Sirimarco MT, Ziv Y, et al. Anal canal inflammation after ileal pouch-anal anastomosis. The need for treatment. Dis Colon Rectum 1995;38:803–806.PubMedCrossRefGoogle Scholar
  46. 46.
    Subramani K, Harpaz N, Bilotta J, et al. Refractory pouchitis: does it reflect underlying Crohn’s disease. Gut 1993;34:1539–1542.PubMedCrossRefGoogle Scholar
  47. 47.
    Pezim ME, Pemberton JH, Beart RW, et al. Outcome of indeterminant colitis. Dis Colon Rectum 1989; 32:653–658.PubMedCrossRefGoogle Scholar
  48. 48.
    Kock NG. Present status of continent ileostomy: surgical revision of the malfunctioning ileostomy. Dis Colon Rectum 1976;19:200–206.PubMedCrossRefGoogle Scholar
  49. 49.
    Hultén L, Svaninger G. Facts about the Kock continent ileostomy. Dis Colon Rectum 1984;27:553–557.PubMedCrossRefGoogle Scholar
  50. 50.
    Stryker SJ, Kelly KA, Phillips SF, et al. Anal and neorectal function after ileal pouch-anal anastomosis. Ann Surg 1986;203:55–61.PubMedCrossRefGoogle Scholar
  51. 51.
    O’Connell PR, Rankin DR, Weiland LH, et al. Enteric bacteriology, absorption, morphology and emptying after ileal pouch-anal anastomosis. Br J Surg 1986;73:909–914.PubMedCrossRefGoogle Scholar
  52. 52.
    Heppell J, Belliveau P, Taillefer R, et al. Quantitative assessment of pelvic ileal reservoir emptying with a semisolid radionuclide enema. A correlation with clinical outcome. Dis Colon Rectum 1987;30:81–85.PubMedCrossRefGoogle Scholar
  53. 53.
    Nasmyth DG, Johnston D, Godwin PG, et al. Factors influencing bowel function after ileal pouch-anal anastomosis. Br J Surg 1986;73:469–473.PubMedCrossRefGoogle Scholar
  54. 54.
    Kelly DG, Phillips SF, Kelly KA, et al. Dysfunction of the continent ileostomy: clinical features and bacteriology. Gut 1983;24:193–201.PubMedCrossRefGoogle Scholar
  55. 55.
    Hill MJ, Fernandez F, Bacteriology II in Pouchitis (Workshop). Int J Colorectal Dis 1989;4:217–219.Google Scholar
  56. 56.
    Nasmyth DG, Godwin PG, Dixon MF, et al. Ileal ecology after pouch-anal anastomosis or ileostomy. A study of mucosal morphology, fecal bacteriology, fecal volatile fatty acids, and their interrelationship. Gastroenterology 1989;96:817–824.PubMedGoogle Scholar
  57. 57.
    Luukkonen P, Valtonen V, Sivonen A, et al. Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis. Dis Colon Rectum 1988; 31:864–867.PubMedCrossRefGoogle Scholar
  58. 58.
    Onderdonk AB, Dvorak AM, Cisneros RL, et al. Microbiologic assessment of tissue biopsy samples from ileal pouch patients. J Clin Microbiol 1992;30:312–317.PubMedGoogle Scholar
  59. 59.
    Dube S, Heyen S. Pouchitis and gastric hyposecretion: cause or effect? Int J Colorectal Dis 1990;5:142–143.PubMedCrossRefGoogle Scholar
  60. 60.
    Santavirta J, Mattila J, Kokki M, et al. Mucosal morphology and faecal bacteriology after ileoanal anastomosis. Int J Colorectal Dis 1991;6:38–41.PubMedCrossRefGoogle Scholar
  61. 61.
    Ruseler-van Embden JG, Schouten WR, van Lieshout LM. Pouchitis: result of microbial imbalance? Gut 1994;35:658–664.PubMedCrossRefGoogle Scholar
  62. 62.
    Podolsky DK, Isselbacher KJ. Glycoprotein composition of colonic mucosa. Specific alterations in ulcerative colitis. Gastroenterol 1984;87:991–998.Google Scholar
  63. 63.
    Corfield AP, Warren BF, Bartolo DC, et al. Mucin changes in ileoanal pouches monitored by metabolic labelling and histochemistry. Br J Surg 1992;79:1209–1212.PubMedCrossRefGoogle Scholar
  64. 64.
    Clausen MR, Tvede M, Mortensen PB. Short-chain fatty acids in pouch contents from patients with and without pouchitis after ileal pouch-anal anastomosis. Gastroenterology 1992;103:1144–1153.PubMedGoogle Scholar
  65. 65.
    Patel RT, Bain I, Youngs D, et al. Cytokine production in pouchitis is similar to that in ulcerative colitis. Dis Colon Rectum 1995;38:831–837.PubMedCrossRefGoogle Scholar
  66. 66.
    Levin KE, Pemberton JH, Phillips SF, et al. Role of oxygen free radicals in the etiology of pouchitis. Dis Colon Rectum 1992;35:452–456.PubMedCrossRefGoogle Scholar
  67. 67.
    Perbeck L, Lindqvist K, Liljeqvist L. The mucosal blood flow in pelvic pouches in man: a methodologic study of fluorescein flowmetry. Dis Colon Rectum 1985;28:931–936.PubMedCrossRefGoogle Scholar
  68. 68.
    Sakaguchi M, Hosie K, Tudor R, et al. Mucosal blood flow following restorative proctocolectomy: pouchitis is associated with mucosal ischemia. Br J Surg 1989;76:1331.Google Scholar
  69. 69.
    Levin KE, Pemberton JH, Phillips SF, et al. Role of oxygen free radicals in the etiology of pouchitis. Dis Colon Rectum 1991;34:P20.Google Scholar
  70. 70.
    Colombel JF, Reumaux D, Duthilleul P, et al. Antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease. Gastroenterol Clin Biol 1992; 16:656–660.Google Scholar
  71. 71.
    de Silva HJ, Jones M, Prince C, et al. Lymphocytes and macrophage subpopulations in pelvic ileal pouches. Gut 1991;32:1160–1165.PubMedCrossRefGoogle Scholar
  72. 72.
    Gertner DJ, Rampton DS, Madden MV, et al. Increased leukotreine by release from ileal pouch mucosa in ulcerative colitis compared with familial adenomatous polyposis. Gut 1994;35:1429–1432.PubMedCrossRefGoogle Scholar
  73. 73.
    Greenberg GR, Buchan AM, McLeod RS, et al. Gut hormone response after reconstructive surgery for ulcerative colitis. Gut 1989;30:1721–1730.PubMedCrossRefGoogle Scholar
  74. 74.
    Fischer JE, Nussbaum MS, Martin CW, et al. The pull-through procedure: technical factors in influencing outcome, with emphasis on pouchitis. Surgery 1993;114:828–834.PubMedGoogle Scholar
  75. 75.
    Nygaard K, Bergan T, Bjornek-Lett A, et al. Topical metronidazole in treatment of pouchitis. Scand J Gastroenterol 1994;29:462–467.PubMedCrossRefGoogle Scholar
  76. 76.
    Miglioli M, Barbara L, DiFetso G, et al. Topical administration of 5-amino salicylic: a therapeutic proposal for the treatment of pouchitis (letter). N Engl J Med 1989;320;257.PubMedGoogle Scholar
  77. 77.
    Brattsand R. Overview of newer glucocorticosteroid preparations for inflammatory bowel disease. Can J Gastroenterol 1990;4:407–414.Google Scholar
  78. 78.
    Wischmeyer PE, Tremaine WJ, Addad AC, et al. Fecal short chain fatty acids in patients with pouchitis after ileal pouch anal anastomosis (abstract). Gastroen-terology 1991;100:848.Google Scholar
  79. 79.
    Ojerskog B, Kock NG, Nilsson LO, et al. Long-term follow-up of patients with continent ileostomies. Dis Colon Rectum 1990;33:184–189.PubMedCrossRefGoogle Scholar
  80. 80.
    Lofberg R, Liljeqvist L, Lindqvist K, et al. Dysplasia and DNA aneuploidy in pelvic pouch. Report of a case. Dis Colon Rectum 1991;34:280–284.PubMedCrossRefGoogle Scholar
  81. 81.
    Veress B, Reinholt FP, Lindqvist K, et al. Long-term histomorphological surveillance of the pelvic ileal pouch: dysplasia develops in a subgroup of patients. Gastroenterology 1995;109:1090–1097.PubMedCrossRefGoogle Scholar
  82. 82.
    Mignon M, Settler C, Phillips SF, Pouchitis—a poorly understood entity. Dis Colon Rectum 1995;38:100–103.PubMedCrossRefGoogle Scholar
  83. 83.
    Gemlo BT, Wong WD, Rothenberger DA, et al. Ileal pouch-anal anastomosis. Patterns of failure. Arch Surg 1992;127:784–786; discussion 787.PubMedCrossRefGoogle Scholar
  84. 84.
    Fonkalsrud EW. Update on clinical experience with different surgical techniques of the endorectal pull-through operation for colitis and polyposis. Surg Gynecol Obstetr 1987;165:309–316.Google Scholar

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© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Jacques Heppell
  • Keith A. Kelly

There are no affiliations available

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