ASSESSMENT OF PERIPOUCH INFLAMMATION AFTER ILEOANAL ANASTOMOSIS USINGENDOLUMINAL ULTRASONOGRAPHY

PURPOSE: This study was designed to assess the impact of endoluminal t ranspouch ultrasonography in the investigation and management of infla mmatory complications of pelvic pouches and to compare endoluminal tra nspouch ultrasonography to pouchography and computerized axial tomogra ph scanning. METHODS: A prospective evaluation was made of the present ation, investigation, treatment, and clinical outcome of 16 patients r eferred for endoluminal transpouch ultrasonography with dysfunctional pelvic pouches and no evidence of pouchitis on endoscopy. RESULTS: The re were 5 normal and 11 abnormal examinations. Six patients had peripo uch inflammatory phlegmons, four patients had peripouch abscesses, and one patient had a rectovaginal fistula. A total of nine patients had anastomotic leaks detected. Two patients had abscesses drained under u ltrasound guidance and a pigtail catheter left in situ. Pouchography d etected only 3 of 8 (38 percent) anastomotic leaks detected by endolum inal transpouch ultrasonography. Computerized axial tomograph scan det ected 2 of 5 (40 percent) peripouch abscesses or phlegmon detected by endoluminal transpouch ultrasonography. Patients with peripouch sepsis had significantly thicker anal wall thickness (23.8 vs. 16.8 mm; P < 0.02) and external sphincter thickness (9.1 vs. 7.3 mm; P < 0.05) than pouches with no sepsis. CONCLUSIONS: Endoluminal transpouch ultrasono graphy appears to detect anastomotic leaks and peripouch sepsis and ma y guide the initial management of patients with dysfunctional pelvic p ouches and an inconclusive clinical and endoscopic examination.