Outcome of "indeterminant" colitis following ileal pouch-anal anastomosis.
To establish whether patients with indeterminant colitis (patients with ulcerative colitis whose surgical specimens also show features of Crohn's colitis) have an adverse outcome after ileal pouch-anal anastomosis (IPAA), the authors reviewed the pathologic reports and postoperative status of 514 consecutive patients who underwent IPAA for chronic ulcerative colitis (CUC). Twenty-five patients (5 percent) had features of indeterminant colitis (IC), including unusual distribution of inflammation, deep linear ulcers, neural proliferation, transmural inflammation, fissures, creeping fat, and retention of goblet-cell population. The clinical and functional outcome of these 25 IC patients was compared with that of the remaining 489 CUC patients. The mean follow-up was 38 +/- 18 months. No significant differences in complication rates, pouch function, incidence of "pouchitis," or requirement for pouch excision were detected in the two groups at follow-up. Although the authors are continuing to perform IPAA on patients with IC, a better definition of the IC patient and a more objective, prospective analysis of outcome of IC following IPAA is required before confident and specific treatment policies can be recommended.
Pezim
M E
ME
Section of Colon and Rectal Sugery, Mayo Clinic, Rochester, Minnesota 55905.
Pemberton
J H
JH
Beart
R W
RW
Wolff
B G
BG
Dozois
R R
RR
Nivatvongs
S
S
Devine
R
R
Ilstrup
D M
DM
D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D003424:Crohn Disease / Q000503:physiopathology / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation