Zusammenfassung
Bestimmte Erkrankungen erfordern die Entfernung des gesamten Kolons, einschließlich der Schleimhautanteile, die im Analkanal bis an die Linea dentata heranreichen (s. folgende Übersicht). Während dieser Eingriff für die Patienten früher den Verlust des fäkalen Kontinenzorganes und Anlage einer terminalen Ileostomie bedeutete, stellt jetzt mit der Einnaht eines Dünndarmreservoirs in den erhaltenen muskulären Analkanal (ileumpouchanale Anastomose —; „Pouch-Op“) ein rekonstruktives Verfahren zur Verfügung, das Radikalität und restaurativen Komfort erfolgreich miteinander vereint (Fazio et al. 1995, Runkel et al. 1998). Den guten chirurgisch-technischen Ergebnissen des Verfahrens steht die Entwicklung einer Pouchitis einschränkend gegenüber, die in Abhängigkeit von der Grunderkrankung bei bis zu einem Drittel der Patienten im ersten Jahr nach „Pouch-Op“auftreten kann (Fazio et al. 1995). Die Entzündung in von Fäzes ausgeschalteten Kolonabschnitten („Diversionskolitis“) ist wie die Pouchitis letztlich ein iatrogenes Krankheitsbild und teilt einige Stigmata mit chronisch entzündlichen Darmerkrankungen. Es ist das Ziel der vorliegenden Arbeit, eine aktuelle Übersicht über Pathogenese, Diagnostik und Therapie der Pouchitis und der Diversionskolitis vorzustellen.
Chapter PDF
Similar content being viewed by others
Literatur
Apel R, Cohen Z, Andrews CR Jr, McLeod R, Steinhart H, Odze RD (1994) Prospective evaluation of early morphological changes in pelvic ileal pouches. Gastroenterology 107: 435
Belluzzi A, Campieri M, Gionchetti P, Boschi S (1993) Acute pouchitis: 5-aminosalicylic acid and budesonide suppositories effectiveness on inflammatory mediator production. Gastroenterology 104: A665
Biasco G, Di Febo G, Gizzi G, Lauri A (1989) Topical 5-aminosalicylic acid for pouchitis and for non-ulcerative ano-rectal diseases. Ital J Gastroenterol 21: Suppl 20
Clausen MR, Tvede M, Mortensen PM (1992) Short chain fatty acids in pouch contents from patients with and without pouchitis after ileal pouch-anal anastomosis. Gastroenterology 103: 1144
Edwards CM, George B, Warren B (1999) Diversion colitis-new light through old windows. Histopathology 34: 1
Esteve M, Mallolas J, Klaassen J et al. (1996) Antineutrophil cytoplasmatic antibodies in sera from colectomised ulcerative colitis patients and its relation to the presence of pouchitis. Gut 38: 894
Fazio VW, ZivY, Church JM, Oakley JR, Lavery IC, Milsom JW, Schroeder TK (1995) Ileal pouch-anal anastomosis complications and function in 1005 patients. Ann Surg 222: 120
Finnie I A, Taylor BA, Rhodes JM (1993) Ileal and colonic epithelial metabolism in quiescent ulcerative colitis: increased glutamine metabolism in distal colon but no defect in butyrate metabolism. Gut 34: 1552
Foley EF, Schoetz DJ Jr, Roberts PL (1995) Rediversion after ileal pouch-anal anastomosis: causes of failures and predictors of subsequent pouch salvage. Dis Colon Rectum 38: 793
Galandiuk S, Scott NA, Dozois RR et al. (1990) Ileal pouch-anal anastomosis. Reoperation for pouch-related complications. Ann Surg 212: 446
Gionchetti P, Rizzello F, Ferrieri A et al. (1999) Rifaximin in patients with moderate or severe ulcerative colitis refractory to steroid treatment: a double-blind, placebo-controlled trial. Dig Dis Sci 44: 1220
Guillemot F, Colombel JF, Neut C, Verplanck N, Lecomte M, Romond C, Paris JC, Cortot A (1991) Treatment of diversion colitis by short chain fatty acids. Prospective and double blind study. Dis Colon Rectum 34: 861
Gullberg K, Stahlberg D, Liljeqvist L, Tribukait B, Reinholt FP, Veress B, Lofberg R (1997) Neoplastic transformation of the pelvic pouch mucosa in patients with ulcerative colitis. Gastroenterology 112: 1487
Harig JM, Soergel KH, Komorowski RA, Wood CM (1989) Treatment of diversion colitis with short chain fatty acid irrigation. N Engl J Med 320: 23
Heppell J, Weiland LH, Perrault J, Pemberton JH, Telander RL, Beart RW Jr (1983) Fate of the rectal mucosa after rectal mucosectomy and ileoanal anastomosis. Dis Colon Rectum 26: 768
Heuschen UA, Heuschen G, Herfarth Ch (1999) Der ileoanale Pouch als Rectumersatz. Chirurg. 70: 530
Hrung JM, Levine MS, Rombeau JL, Rubesin SE, Laufer I (1998) Total proctocolectomy and ileoanal pouch: the role of contrast studies for evaluating postoperative leaks. Abdom Imaging 23: 375
Hurst RD, Molinari M, Chung TP, Rubin M, Michelassi F (1996) Prospective study of the incidence, timing, and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy. Arch Surg 131: 497
Hurst RD, Chung TP, Rubin M, Michelassi F (1998) The implications of acute pouchitis on the long-term functional results after restorative proctocolectomy. Inflamm Bowel Dis 4: 280
Kmiot WA, Youngs D, Tudor R, Thompson R, Keighley MR (1993) Mucosal morphology, cell proliferation and faecal bacteriology in acute pouchitis. Br J Surg 80: 1445
Kollmorgen CF, Nivatvongs S, Dean PA, Dozois RR (1996) Long-term causes of death following ileal pouch-anal anastomosis. Dis Colon Rectum 39: 525
Komorowski RA (1990) Histological spectrum of diversion colitis. Am J Surg Pathol 14: 548
Kühbacher T, Schreiber S, Runkel N (1998) Pouchitis: pathophysiology and treatment. Int J Colorect Dis 13: 196
Lerch MM, Braun J, Hander M, Hofstadter F, Schumpelick V, Matern S (1989) Postoperative adaptation of the small intestine after total colectomy and J-pouch-anal anastomosis. Dis Colon Rectum 33: 91
Levin KE, Pemberton JH, Phillips SF, Zinsmeister AR, Pezim ME (1992) Role of oxygen free radicals in the aetiology of pouchitis. Dis Colon Rectum 35: 452
Libicher M, Scharf J, Wunsch A, Stern J, Dux M, Kauffmann GW (1998) MRI of pouch-related fistulas in ulcerative colitis after restorative proctocolectomy. J Comput Assist Tomogr 22: 664
Lohmuller JL, Pemberton JH, Dozois RR, Ilstrup D, van Heerden J (1990) Pouchitis and extraintestinal manifestations of inflammatory bowel disease after pouch-anal anastomosis. Ann Surg 211: 622
Madden MV, Mclntyre AS, Nicholls RJ (1994) Doubleblind crossover trial of metronidazole versus placebo in chronic remitting pouchitis. Dig Dis Sci 39: 1193
Mclntyre PB, Pemberton JH, Wolff BG, Dozois RR, Beart RW Jr (1995) Indeterminate colitis. Long-term outcome in patients after ileal pouch-anal anastomosis. Dis Colon Rectum 38: 51
Meagher AP, Farouk R, Dozois RR, Kelly KA, Pemberton JH (1998) J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg 85: 800
Merret MN, Kettlewell M (1996) Smoking may prevent pouchitis in patients with restorative proctocolectomy for ulcerative colitis. Gut 38: 362
Meuwissen SCM, Hoitsma H, Boot H, Seldenrijl CA (1989) Pouchitis ( Pouch ileitis ). Neth J Med 35: 554
Mortensen PB, Clausen MR (1996) Short chain fatty acids in the human colon: relation to gastrointestinal health and disease. Scand J Gastroenterol 31: 132
Moskowitz RL, Shepherd NA, Nicholls RJ (1986) An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorect Dis 1: 167
Nygaard K, Bergan T, Bjorneklett A, Hoverstad T, Lassen J, Aase S (1994) Topical metronidazole treatment in pouchitis. Scand J Gastroenterol 29: 462
O’Connell PR, Rankin DH, Weilan LH, Kelly KA (1986) Enteric bacteriology, absorption, morphology and emptying after ileal pouch anal anastomosis. Br J Surg 73: 909
Penna C, Dozois RR, Tremaine WJ, Sandborn W, Larusso N, Schleck G, Ilstrup D (1996) Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut 38: 504
Puthu D, Rajan N, Rao R, Rao L, Venugopal P (1992) Carcinoma of the rectal pouch following restorative proctocolectomy. Report of a case. Dis Colon Rectum 35: 257
Rauh SM, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1991) Pouchitisis it a wastebasket diagnosis Dis Colon Rectum 34: 685
Rodriguez-Sanjuan JC, Polavieja MG, Navanjo A, Castillo J (1995) Adenocarcinoma in an ileal pouch for ulcerative colitis. Dis Colon Rectum 38: 779
Runkel N, Kroesen AJ, Buhr HJ (1998) Technische Aspekte und Ergebnisse nach ileoanaler Pouchanlage wegen Colitis ulcerosa. Zentralbl Chir 123: 375
Sagar PM, Taylor BA, Godwin P et al. (1995) Acute pouchitis and deficiencies of fuel. Dis Colon Rectum 38: 488
Sandborn WJ, Tremaine WJ, Batts KP, Pemberton JH, Phillips SF (1994) Pouchitis after pouchanal anastomosis: a pouchitis disease activity index. Mayo Clin Proc 69: 410
Sandborn WJ, Landers CJ, Tremaine WJ, Targan SR (1995) Antineutrophil cytoplasmatic antibody correlates with chronic pouchitis after ileal pouch-anal anastomosis. Am J Gastroenterol 90: 740
Sarigol S, Wyllie R, Grämlich T, Alexander F, Fazio VW, Kay M, Mahajan L (1999) Incidence of dysplasia in pelvic pouches in pediatric patients after ileal pouch-anal anastomosis for ulcerative colitis. J Pediatr Gastroenterol Nutr 28: 429
Seidel SA, Peach SE, Newman M, Sharp KW (1999) Ileoanal pouch procedures: clinical outcomes and quality of life assessment. Am Surg 65: 40
Sequens R (1997) Cancer in the anal canal (transitional zone) after restorative proctocolectomy with stapled ileal pouch-anal anastomosis. Int J Colorect Dis 12: 254
Setti-Carraro PG, Talbot IC, Nicholls JR (1998) Patterns of distribution of endoscopic and histological changes in the ileal reservoir after restorative proctocolectomy for ulcerative colitis. A long-term follow up study. Int J Colorect Dis 13: 103
Shepherd NA, Healey CJ, Warren BF, Richman PI, Thomson WH, Wilkinson SP (1993) Distribu¬tion of mucosal pathology and an assessment of colonic phenotypic change in the pelvic ileal reservoir. Gut 34: 101
Solomon MJ, McLeod RS, O’Connor BI, Cohen Z (1995) Assessment of peripouch inflammation after ileoanal anastomosis using endoluminal ultrasonography. Dis Colon Rectum 38: 182
Stallmach A, Moser C, Hero-Gross R, Müller-Molaian I, Ecker W, Feifei G, Zeitz M (1999) Pattern of mucosal adaptation in acute and chronic pouchitis. Dis Colon Rectum 42: 1311
Stern H, Walfisch S, Mullen B, McLeod R, Cohen Z (1990) Cancer in an ileo-anal reservoir. A new late complication. Gut 31: 473
Svaninger G, Nordgren S, Oresland T, Hulten L (1993) Incidence and characteristics of pouchitis in the Kock continent ileostomy and the pelvic pouch. Scand J Gastroenterol 28: 695
Thoeni RF, Fell SC, Engelstad B, Schröck TB (1990) Ileoanal pouches: comparison of CT, scintigraphy, and contrast enemas for diagnosing postsurgical complications. Am J Roentgenol 154: 73
Tremaine WJ, Sandborn WJ, Wolff BG, Carpenter HA, Zinsmeister AR, Metzger PP (1997) Bismuth carbomer foam enemas for active chronic pouchitis: a randomized, double-blind, placebo-controlled trial. Aliment Pharmacol Ther 11: 1041
Veress B, Reinholt FP, Lindquist K, Lofberg R, Liljeqvist I (1995) Long term histomorphological surveillance of the pelvic ileal pouch. Dysplasia develops in a subgroup of patients. Gastroenterology 109: 1090
Vieth M, Grunewald M, Niemeyer C, Stolte M (1998) Adenocarcinoma in an ileal pouch after prior proctocolectomy for carcinoma in a patient with ulcerative pancolitis. Virchows Arch 433: 281
Vivoli V, Cobianchi F, Adami M, Torri T, Ferraro G, Roncoroni L (1998) Human defunctionalized colon. A histopathological and pharmacological study of muscularis propria in resected specimens. Dig Dis Sci 43: 616
Warren BF, Shepherd NA, Price AB, Williams GT (1997) Importance of cryptolytic lesions and pericryptal granulomas in inflammatory bowel disease. J Clin Pathol 50: 880
Wischmeyer P, Pemberton JH, Phillips SF (1993) Chronic pouchitis after ileal pouch-anal anastomosis: responses to butyrate and glutamine suppositories in a pilot study. Mayo Clin Proc 68: 978
Yeong ML, Bethwaite PB, Prasad J, Isbister WN (1991) Lymphoid follicular hyperplasia-a distinctive feature of diversion colitis. Histopathology 19: 55
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2001 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Schürmann, G., Brüwer, M., Senninger, N. (2001). Pouchitis und Diversionskolitis. In: Dignass, A., Stein, J. (eds) Chronisch entzündliche Darmerkrankungen. Gastroenterologie Update, vol 2000. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59556-1_6
Download citation
DOI: https://doi.org/10.1007/978-3-642-59556-1_6
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-67722-2
Online ISBN: 978-3-642-59556-1
eBook Packages: Springer Book Archive