Pouch wall thickness and floppy pouch complex
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and Other Interventional Techniques
Pouch wall thickness and floppy pouch complex Khan Freeha1 · Sze Grace1 · Lan Nan2 · Xian Hua Gao2 · Tracy L. Hull2 · Bo Shen1 Received: 21 October 2018 / Accepted: 9 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Floppy pouch complex (FPC) consists of disease phenotypes in patients with ileal pouches, including pouch prolapse, afferent limb syndrome, enterocele, redundant loop, and pouch folding. Our recent study demonstrated that lower body weight, lower peripouch fat, family history of inflammatory bowel disease (IBD), female gender, and dyschezia are risk factors for FPC patients with IBD. The aims of this study were to assess the relationship between pouch wall thickness and FPC, and to investigate the association between inflamed and non-inflamed pouch wall thickness. Methods This case–control study included all eligible patients with FPC from our prospectively maintained, IRB-approved Pouchitis Registry from 2011 to 2017. We measured pouch wall thickness of fully distended pouches on cross-sectional abdominal and pelvic imaging. Patients with stoma and non-distended pouches were completely excluded. Risk factors for FPC were analyzed. Results A total of 140 out of 451 patients from our were found to have fully distended pouches on imaging. Of the 140 patients, 36 (25.7%) were diagnosed as having FPC. We analyzed pouch wall thickness for each subcategory of FPC as well as non-FPC conditions. The thickness of pouch wall was follows: pouch prolapse (N = 19): 1.5 mm (1.5–2.0), afferent limb syndrome (N = 12): 1.5 mm (1.1–2.0), folded pouch (N = 4): 1.5 mm (1.1–1.9), and redundant pouch (N = 2): 1.3 mm (1.0–1.3). The control group (N = 104) consisting of normal pouch, pouchitis, cuffitis, Crohn’s disease of the pouch, and pouch sinus with median pouch wall thickness of 1.5 mm, 2.3 mm, 2.0 mm, 2.0 mm, and 1.5 mm, respectively. There were significant differences in pouch wall thickness between normal or non-inflamed pouch versus pouchitis versus cuffitis versus Crohn’s disease of the pouch with p values of 0.01, 0.04, 0.05, and 0.049, respectively. Conclusion Patients with FPC were shown to have thin pouch wall, which those with inflammatory conditions of the pouch tended to have thick pouch wall. These findings will have implications in both diagnosis and investigation of etiopathogenesis of these disorders. Keywords Afferent limb syndrome · Floppy pouch complex · Ileal pouch-anal anastomosis · Inflammatory bowel disease · Pouch wall thickness · Prolapse · Restorative proctocolectomy Abbreviations ALS Afferent limb syndrome BD Barium defecography BMI Body mass index CD Crohn’s disease EIM Extra-intestinal manifestations FAP Familial adenomatous polyposis * Bo Shen [email protected]; [email protected] 1
Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic
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