Chronic Pouchitis Versus Recurrent Crohn’s Disease: A Diagnostic Challenge

Excerpt

Up to one-third of patients with ulcerative colitis will require total abdominal colectomy due to being refractory to therapy or the development of mucosal dysplasia or carcinoma. In these patients, the restorative procedure of choice is ileal pouch-anal anastomosis (IPAA), in which the distal ileum is formed into a pouch and anastomosed to the anus. Such a pouch creates a reservoir, which, when functioning properly, will minimize the frequency of bowel movements in the absence of a colon. One frequent complication of IPAA, however, is the development of pouch inflammation, known as pouchitis, which occurs in 15 % of patients in the first post-operative year [6]. The majority of patients with pouchitis are successfully managed with antibiotics, though a portion experience multiple recurrent episodes. Some patients develop inflammation proximal to the pouch or even develop penetrating transmural complications suggesting a diagnosis of Crohn’s disease. …