title: Anal canal inflammation after ileal pouch-anal anastomosis. The need for treatment.
abstract: One technique used during restorative proctocolectomy to prevent loss of continence involves preservation of the anal canal. This technique retains a small amount of colonic mucosa and transitional mucosa that may become inflamed or develop dysplastic or neoplastic changes.
  
  
  OBJECTIVE
  This study was designed to determine the presence and severity of anal canal inflammation and the need for treatment.
  
  
  METHODS
  Records of 217 patients with mucosal ulcerative colitis who underwent restorative proctocolectomy with a stapled ileal pouch-anal anastomosis without anal mucosectomy from 1987 through 1990 were retrospectively reviewed.
  
  
  RESULTS
  Anal canal inflammation was evident on both endoscopy and biopsy in 48 patients (22.11 percent); 18 patients (8.29 percent) had a normal ileal pouch (9 had symptoms; 5 required topical treatment), and 30 patients (13.82 percent) had associated ileal pouch inflammation (23 with symptoms requiring systemic treatment because of pouchitis; 10 patients had concomitant topical treatment).
  
  
  CONCLUSIONS
  Symptomatic inflammation of the retained mucosa occurred in 32 (14.7 percent) patients. Nine (4.1 percent) patients had inflammation of the anal canal alone, and 23 (10.6 percent) had pouchitis in addition. The need for treatment occurred in 28 (12.9 percent) of the total ((2.3 percent) patients with anal canal inflammation and 23 (10.6 percent) with anal canal inflammation plus pouchitis).
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: I C
authors.initials: IC
authors.lastname: Lavery
authors.forename: M T
authors.initials: MT
authors.lastname: Sirimarco
authors.forename: Y
authors.initials: Y
authors.lastname: Ziv
authors.forename: V W
authors.initials: VW
authors.lastname: Fazio
mesh_terms: D000285:Administration, Rectal; D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology / Q000601:surgery; D001706:Biopsy; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use; D007079:Ileitis / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D011349:Proctitis / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012189:Retrospective Studies; D012812:Sigmoidoscopy; D017792:Surgical Stapling
chemical_list: D008795:Metronidazole; D002939:Ciprofloxacin; D011241:Prednisone; D006854:Hydrocortisone