Total abdominal colectomy (TAC) with ileal pouch anal anastomosis (IPAA) is performed for patients with medically refractory ulcerative colitis (UC) or colonic neoplasia. Ineffective pouch emptying is under-recognized in these patients. In this study we sought to evaluate the evacuation characteristics of the ileal pouch in patients who have undergone IPAA procedure.Methods:
Through an IRB approved protocol, eligible adult patients with a confirmed diagnosis of UC and a history of TAC with IPAA were identified from the outpatient practice of gastroenterologists and colorectal surgeons at the Mayo Clinic. Pregnant women and those with symptoms suggestive of active inflammation (increase in bowel frequency > 3 bowel movements over baseline, bleeding, urgency, or fever > 100.5°F) were excluded from the study. Enrolled subjects underwent measurement of compliance and sensation of the ileal pouch. Balloon expulsion test was performed and followed by scintigraphic study of ileal pouch motor function using 1 mCi Tc-99m sulfur colloid in Veegum gel. The relative percent emptying of the ileal pouch were determined.Results:
A total of 35 patients (mean age 46.7, 40% Female) were prospectively enrolled and underwent pouch evacuation studies. The mean pouch duration from the time of ostomy was 7.8 years. Out of these 18 (51.4%) patient had a history of recurrent pouchitis and 9 (25.7%) were on antibiotics. The mean pressure for first sensation, gas, urge and pain was 7.3, 12.4, 21.4 and 30.9 mm Hg respectively. Thirteen (41%) failed balloon expulsion test. The mean percentage of evacuation was 73.4% on the scintigraphic study. None of these dynamics were significantly different between patient with normal pouch and those with history of recurrent pouchitis.Conclusions:
Abnormal balloon expulsion test is frequent in patients with IPAA suggesting pouch evacuation disorders are common in this patient population. Further studies are needed to define the typical range of anorectal manometry values for normal pouch function.