NEOPLASIA IN ILEAL POUCH MUCOSA AFTER TOTAL PROCTOCOLECTOMY FOR JUVENILE POLYPOSIS - REPORT OF A CASE

PURPOSE: Patients treated with restorative proctocolectomy for familia l adenomatous polyposis or ulcerative colitis occasionally develop dis ease in the ileal pouch similar to that originally present in the colo n. We investigated the possibility of analogous involvement in the ile al pouch of juvenile polyposis patients. METHODS: Endoscopic surveilla nce for neoplasia throughout the gastrointestinal tract was performed, with retrieval of all polypectomy specimens for histologic classifica tion using the criteria of Morson. RESULTS: Multiple large juvenile po lyps were found in the ileal pouch of one patient less than 10 years a fter restorative proctocolectomy for hereditary juvenile polyposis. Th e pouch was much more severely affected than the proximal ileum, small intestine, or stomach. Although most polyps had a completely benign h istologic appearance, three had moderate to severe dysplasia. DISCUSSI ON: Mucosal changes induced by bacteria or stasis of luminal contents may promote manifestation in the ileal pouch of the disease phenotype usually more evident in the colon. Patients with severe or generalized juvenile polyposis should be considered for periodic endoscopic surve illance of the ileal pouch beginning several years after restorative p roctocolectomy.