Optimal Management of Pelvic Abscess After Pouch Surgery

Abstract

For patients who undergo ileal pouch anal anastomosis (IPAA), pelvic sepsis is the leading cause of pouch failure. In order to treat pouch abscess effectively, it is important to identify whether the abscess is associated with a pouch leak. If there is an associated leak, it is important to ascertain where anatomically the pouch is leaking: the tip of the J pouch, the body of the J pouch, or the ileal pouch anal anastomosis. There are two ways to treat pouch abscess other than exploration and washout: percutaneous drainage and trans-anastomotic drainage. This chapter seeks to identify which of these methodologies is superior in regards to abscess eradication, pouch function, and pouch loss. Overall, both modalities did have success in abscess eradication and prevention of pouch loss. About 80–90% of pouches were able to be preserved using either of these methodologies. For all clinically stable patients with pelvic abscess associated with IPAA, attempts should be made to treat the pelvic abscess and preserve the pouch regardless of treatment modality.