CLINICAL AND PHYSIOLOGICAL-ASPECTS OF ILEAL POUCH-ANAL ANASTOMOSIS

Proctocolectomy with ileal pouch-anal anastomosis is the surgical trea tment of choice for severe chronic ulcerative colitis and familial pol yposis coli because the entire colonic mucosa is removed while anal fu nction can be preserved and the necessity for permanent ileostomy is e liminated. Long-term functional results are generally gratifying, as d efecation frequency and degree of incontinence are acceptable in most patients. Pouchitis, however, a non-specific inflammation of the ileal reservoir, is a major long-term complication occurring in a considera ble number of patients. The etiology of pouchitis is unknown. Since po uchitis occurs more frequently or even exclusively in ulcerative colit is patients it is assumed that pouchitis is a novel manifestation of i nflammatory bowel disease. However, bacterial overgrowth in the ileal pouch may also play a pathogenetic role. Chronic inflammation and vill ous atrophy of varying severity is found in virtually all pouches. Acu te inflammatory changes and ulceration are associated with pouchitis.