Ileal-anal pouches: A review of its history, indications, and complications

Figure 1 History of the ileal pouch. A: The Kock continent ileostomy; B: Common pouch configurations used in ileal pouches.

Figure 2 Endo-cavitational vacuum therapy (Endo-SPONGE^®). A: Endoscopic view of a pouch with a cavity (arrow) at the anastomosis secondary to anastomotic leak. The true lumen is at the inferior aspect; B: Contents of the Endo-SPONGE^® kit (B Braun Medical Ltd); C: The foam of the Endo-SPONGE^® is passed into the cavity and negative pressure applied to collapse the cavity.

Figure 3 Examination under anaesthesia performed for a female patient who presented with perineal sepsis and abnormal per vaginal discharge following ileal pouch anal anastomosis. A pouch-vaginal fistula was identified and confirmed with a probe.

Figure 4 A coronal computed tomography image of a patient who presented with early small bowel obstruction following closure of ileostomy (6 mo post pouch creation). Computed tomography and operative findings confirmed small bowel obstruction secondary to a 360° twist at the level of the anastomosis.

Figure 5 Obstruction to pouch outflow usually occurs at the level of the anastomosis. A: A coronal computed tomography image demonstrating a pouch outlet stricture. A stricture at the level of the anastomosis (arrow) caused a dilated pouch that could not empty without intubation; B: A pouchogram of the same patient confirmed an anastomotic stricture that eventually yielded to serial Hegar dilations.

Figure 6 Endoscopic view of pouchitis (Pouch Disease Activity Index endoscopic sub-score 4).

Figure 7 Pouch adenoma. A: Magnetic resonance image and endoscopic view of a pedunculated pouch polyp (arrow) arising in the mid pouch that was completely excised endoscopically; B: A serrated, near circumferential, lesion (arrow) that required formal pouch excision. Both pouch lesions were confirmed histologically to be pouch adenomas.

Figure 8 A magnetic resonance image of a pouch with a large exophytic lesion (arrow) arising from its posterior aspect. Biopsies and formal histopathology confirmed this to be a pouch carcinoma.