Review
Copyright ©The Author(s) 2019.
World J Gastroenterol. Aug 21, 2019; 25(31): 4320-4342
Published online Aug 21, 2019. doi: 10.3748/wjg.v25.i31.4320
Table 1 Complications following ileal pouch anal anastomosis
Complications following IPAA
Early
Haemorrhage
Staple line bleeding
Pouch ischaemia
Intraabdominal bleeding
Intramural haematoma
Acute pelvic sepsis
Anastomotic leak
Infected haematoma
Portal vein thrombus
Late
Chronic pelvic sepsis
Pouch fistulae (pouch-vaginal, pouch-anal, pouch perineal)
Small bowel obstruction
Pouch dysfunction
Mechanical causes (obstruction/ pouch stricture, poor compliance)
Pouchitis
Cuffitis
Irritable pouch syndrome
Pouch failure
Dysplasia/malignancy
Cuff dysplasia
Pouch dysplasia
Infertility
Table 2 The pouch disease activity index
Range
I Clinical
1 Stool frequency(0, 1, 2)
2 Faecal urgency/Abdominal cramps(0, 1, 2)
3 Rectal bleeding(0, 1)
4 Fever > 37.8 °C(0, 1)
Maximal clinical sub-score: 6
II Endoscopic finding
1 Oedema(0, 1)
2 Granularity(0, 1)
3 Friability(0, 1)
4 Loss of vascular pattern(0, 1)
5 Mucous exudates(0, 1)
6 Ulcerations(0, 1)
Maximal endoscopic sub-score: 6
III Histology-acute histological inflammation
1 Polymorphonuclear infiltration(0, 1, 2, 3)
2 Ulceration per low power field (mean)(0, 1, 2, 3)
Maximal histological sub-score: 6
Maximal total PDAI: 18
Table 3 The Cleveland Clinic Foundation ileal pouch failure score
Risk factorPoints
Diagnosis
FAP0
UC or indeterminate colitis1
Crohn’s disease1.5
Patient co-morbidity
No comorbid conditions0
1 comorbid condition0.5
2 or more comorbid conditions1
Prior anal pathology
No prior anal pathology0
Prior anal pathology1
Anal sphincter manometry
Normal manometry0
Abnormal manometry (squeeze pressure < 100, resting pressure < 40)1
Anastomotic separation
No anastomotic separation0
Anastomotic separation1
Anastomotic stricture
No stricture or asymptomatic stricture0
Symptomatic stricture1
Pelvic sepsis
No sepsis0
One episode of pelvic sepsis1
Two or more episodes of pelvic sepsis2
Fistula formation
No fistula0
Pouch-perineal fistula1
Pouch-vaginal fistula2
TOTAL score