INCIDENCE AND SUBSEQUENT IMPACT OF PELVIC ABSCESS AFTER ILEAL POUCH-ANAL ANASTOMOSIS FOR CHRONIC ULCERATIVE-COLITIS

This study was designed to measure the impact of pelvic abscess on eve ntual pouch failure and functional outcome after ileal pouch-anal anas tomosis in patients with chronic ulcerative colitis. PATIENTS AND METH ODS: The outcome of 1,508 patients who underwent ileal pouch-anal anas tomosis for chronic ulcerative colitis at the Mayo Clinic was determin ed from a central patient registry; data were collected prospectively. RESULTS. Seventy-three patients developed a pelvic abscess as a compl ication of ileal pouch-anal anastomosis. Pouch failure occurred in 19 (26 percent). Forty-eight patients (55 percent) required transabdomina l salvage surgery, 6 (8 percent) underwent local surgery, and the rema ining 27 (37 percent) were treated nonsurgically. Wound infection was more common in patients who experienced pelvic abscess. The majority o f pouch failures secondary to pelvic abscess formation occurred within two years of ileal pouch-anal anastomosis. Daytime incontinence, the use of a protective pad, and the need for constipating or bulking medi cation were significantly more common among patients who had an absces s but kept their reservoir. Ability to perform work and domestic activ ities and to undertake recreational activities were significantly more restricted among these patients. CONCLUSIONS: Pouch failure occurs in one-fourth of patients who retain their pouch despite pelvic abscess after ileal pouch-anal anastmosis. Among patients who retain their pou ch despite postoperative pelvic abscess, functional outcome and qualit y of life are significantly poorer than in patients in whom no sepsis occurred.