Details

Autor(en) / Beteiligte

• Nugent, Emmeline
• Church, James M.

Titel

When pouches cannot empty: a cohort study of the symptoms this causes, the reasons it's happening, and the treatments needed

Ist Teil von

• ANZ journal of surgery, 2022-12, Vol.92 (12), p.3237-3241

Ort / Verlag

Melbourne: John Wiley & Sons Australia, Ltd

Erscheinungsjahr

2022

Quelle

Wiley-Blackwell Journals

Beschreibungen/Notizen

• Background Patients with an ileal pouch have a new system of defecation. The expulsive peristalsis of the rectum is replaced by the inertia of the pouch. Defecation becomes dependent on gravity and patients are prone to inefficient pouch‐emptying. Several factors can impact pouch emptying and here we review a series of patients to illustrate these factors and their variable presentations. Methods This is a retrospective, descriptive study of a series of patients who had undergone total proctocolectomy with ileal pouch anal anastomosis and presented with pouch dysfunction. Patients underwent investigations including, pouchoscopy, pouchography and anorectal physiology testing. Results There were 34 patients, 18 men, mean age 48.4 years. Thirty‐one had a J‐pouch and 3 an S‐pouch. Twenty‐eight had a stapled and 6 a hand‐sewn anastomosis. Presenting complaints included difficulty emptying the pouch (n = 17), high stool frequency (n = 8), clinical bowel obstruction (n = 7), and nocturnal incontinence (n = 3). Diagnoses were anal stenosis (11), afferent‐limb syndrome (n = 7), pouch twist (n = 4), paradoxical puborectalis contraction (n = 7), efferent‐limb spasm/stenosis (n = 2), mega‐pouch (n = 3), pouch prolapse (n = 1), and pouch‐rectal anastomosis (n = 1). Treatments included anal dilation (n = 11), disimpaction (n = 2), biofeedback (n = 2), pouch excision (n = 2), laparotomy with lysis of adhesions (n = 6), Botox injection into puborectalis (n = 6), catheter drainage (3), and miralax (n = 11). All patients with a stenosis had some improvement after dilation, and surgery restored pouch function. Conclusions Accurate diagnosis and effective treatment of pouch dysfunction is based on an appreciation of pouch physiology, correction of anatomic abnormalities that impair emptying, and management of stool consistency. Pouch dysfunction after ileo‐anal pouch is often approached as a disease rather than an expected result of the physiology of defecation in a patient who's rectum has been exchanged for an aperistaltic pouch reservoir. here we review a series of patients with pouch dysfunction in this light.