Acute Pouchitis

IBD of the pouch (pouchitis) is a syndrome defined by clinical, endoscopic and histologic criteria that occurs in UC-IPAA patients (Mahadevan and Sandborn, 2003), and seldom, if ever, affects familial adenomatous polyposis-IPAA patients. Patients complain of fecal frequency, and the motions are commonly loose and watery and may contain mucous and blood. Urgency and leakage, especially at night, are common. In addition, depending on the severity of pouch inflammation, the presence of associated fistulas, CD or concurrent pouch outlet obstruction, pelvic pain may be present. Systemic symptoms of malaise, low-grade fever or weight loss are often present in the more severe cases of pouch inflammation. Physical examination in patients with pouch inflammation is often normal. However, individuals with marked inflammation of the pouch from any cause may have the general features of patients with IBD, with low-grade fever, weight loss, and pallor. CD is suggested by signs of small bowel obstruction, abdominal mass or tenderness, or perineal sepsis.

In most cases, endoscopy and biopsy of the pouch will be diagnostic. We use flexible upper gut endoscopes to examine ileal pouches, because of their narrower caliber and superior flexibility compared to sigmoidoscopes. It must be recognized that even in a healthy pouch, the ileal mucosa undergoes metaplasia to a more colonic type; accordingly, normal ileum is not seen endoscopically or histologically. The presence of edema, erythema, mucous exudates, and ulceration suggest pouch inflammation. If endoscopic changes are confined to the pouch and do not extend into the prepouch ileum, pouchitis is the likely diagnosis. However, if aphthous or deep ulcerations and other mucosal abnormalities extend proximal from the pouch, or are seen solely in the prepouch ileum, CD is more likely. Occasionally, a linear series of shallow ulcerations will be observed extending along the divided pouch septum. This appearance is suggestive of pouch ischemia, a complication that may occur if the mesenteric vessels have been stretched too deeply into the pelvis (de Silva et al, 1991).

Severe microscopic inflammation can be found in a pouch with a relatively normal endoscopic appearance. Thus, biopsy and histological evaluation of the mucosa are essential. An experienced pathologist should be able to distinguish between pouchitis, CD, and mucosal ischemia. Pouchography detects pouch leaks, fistulas and strictures, and thus can be helpful if these complications are suspected, or if pouchitis needs to be differentiated from CD. Almost all cases of acute pouchitis will promptly respond to a course of antibiotics, such as metronidazole 250 to 500 mg 3 times daily or ciprofloxacin 500 mg twice daily for 10 to 14 days. Rarely, cytomegalovirus can infect pouch mucosa leading to chronic inflammation; the diagnosis is suggested by the presence of viral inclusions on histology. Treatment with ganciclovir is reported to be effective.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

Get My Free Ebook


Post a comment