Ileal-anal pouches: A review of its history, indications, and complications

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

IPAA: Ileal pouch anal anastomosis.

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

PDAI: Pouch disease activity index.

Table 3 The Cleveland Clinic Foundation ileal pouch failure score

Risk factor	Points
Diagnosis
FAP	0
UC or indeterminate colitis	1
Crohn’s disease	1.5
Patient co-morbidity
No comorbid conditions	0
1 comorbid condition	0.5
2 or more comorbid conditions	1
Prior anal pathology
No prior anal pathology	0
Prior anal pathology	1
Anal sphincter manometry
Normal manometry	0
Abnormal manometry (squeeze pressure < 100, resting pressure < 40)	1
Anastomotic separation
No anastomotic separation	0
Anastomotic separation	1
Anastomotic stricture
No stricture or asymptomatic stricture	0
Symptomatic stricture	1
Pelvic sepsis
No sepsis	0
One episode of pelvic sepsis	1
Two or more episodes of pelvic sepsis	2
Fistula formation
No fistula	0
Pouch-perineal fistula	1
Pouch-vaginal fistula	2
TOTAL score

This score is interpreted based on the number of years post pouch formation, and a probability of pouch failure is then calculable (http://www.riskprediction.org.uk/index-ccfipf.php). FAP: Familial adenomatous polyposis; UC: Ulcerative colitis.