Abstract
The significance of inflammation of the mucosa of the ileal reservoir after restorative proctocolectomy is not known although in some cases it appears to be associated with symptoms when the condition has been referred to as pouchitis. This investigation has aimed to determine the prevalence of inflammation, to define pouchitis and to examine some factors which might be related to inflammation. Mucosal biopsies from the ileal reservoir were studied in 90 patients at up to 62 months after closure of the ileostomy. A histological grading system (0–6) was used to assess the severity of inflammation. Some degree of chronic and acute inflammation was found in 87% and 30% of cases respectively. The prevalence of a grade of 4 or more was 23% and 3.5%. There was a correlation between severity of chronic and acute inflammation. Severe histological acute inflammation (grade 4–6) was associated with sigmoidoscopic features of inflammation and with increased frequency of defaecation. Of 55 patients sigmoidoscoped by one clinician, 6 (11%) had pouchitis which was characterised by macroscopic inflammation of the reservoir, diarrhoea and a histological grade of 4 or more. The severity of chronic inflammation was not related to frequency of defaecation. Histological inflammation could not be correlated with the type of reservoir, residual volume after evacuation of a known volume of stool substitute introduced per anum into the reservoir or compliance of the reservoir. Acute inflammation was significantly more severe in patients with ulcerative colitis than in those with familial adenomatous polyposis.
Similar content being viewed by others
References
Parks AG, Nicholls RJ, Beleveau P (1980) Proctocolectomy with ileal reservoir and anal anastomosis. Br J Surg 67:533–538
Beart RW, Metcalf AM, Dozois RR, Kelly KA (1985) The J ileal pouch-anal anastomosis: the Mayo Clinic experience. In: Dozois RR (ed) Alternatives to conventional ileostomy. Year Book Medical, Chicago, pp 384–401
Utsunomiya J, Iwama T, Imago M, Matsuo S, Sawai S, Yaegashi K, Hirayama R (1980) Total colectomy, mucosal proctectomy and ileoanal anastomosis. Dis Colon Rectum 23:459–466
Rothenberger DA, Vermeulen FD, Christiansen CE, Balcos EG, Nemer FD, Fang DT, Kennedy HL (1983) Restorative proctectomy with ileal reservoir and ileoanal anastomosis. Am J Surg 145:82–88
Nicholls RJ, Pezim ME (1985) Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatosis polyposis: A comparison of three reservoir designs. Br J Surg 72:470–474
Dozois RR (1985) Ileal J-pouch-anal anastomosis. Br J Surg 72 (Suppl): 580–582
Goldberg SM, Rothenberger DA (1986) Symposium: Restorative proctocolectomy with ileal reservoir. Int J Colored Dis 1:2–19
Fonkalsrud EW (1984) Endorectal ileoanal anastomosis with isoperistalitic ileal reservoir after colectomy and mucosal proctectomy. Ann Surg 199:151–157
Hulten L, Svaninger G (1984) Facts about the Kock continent ileostomy. Dis Colon Rectum 27:553–557
Nasmyth DG, Godwin PGR, Dixon MF, Williams NS, Johnston D (1985) The relationship between mucosal structure and intestinal flora in ileal reservoirs. Br J Surg 72 (Suppl): S. 129
Nicholls RJ, Belleveau P, Neill M, Wilks M, Tabaqchali S (1981) Restorative protectomy with ileal reservoir: a pathophysiological assessment. Gut 22:462–468
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Moskowitz, R.L., Shepherd, N.A. & Nicholls, R.J. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorect Dis 1, 167–174 (1986). https://doi.org/10.1007/BF01648445
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01648445