Incidence and subsequent impact of pelvic abscess after ileal pouch-anal anastomosis for chronic ulcerative colitis.
OBJECTIVE
This study was designed to measure the impact of pelvic abscess on eventual pouch failure and functional outcome after ileal pouch-anal anastomosis in patients with chronic ulcerative colitis.


METHODS
The outcome of 1,508 patients who underwent ileal pouch-anal anastomosis for chronic ulcerative colitis at the Mayo Clinic was determined from a central patient registry, data were collected prospectively.


RESULTS
Seventy-three patients developed a pelvic abscess as a complication of ileal pouch-anal anastomosis. Pouch failure occurred in 19 (26 percent). Forty-eight patients (55 percent) required transabdominal salvage surgery, 6 (8 percent) underwent local surgery, and the remaining 27 (37 percent) were treated nonsurgically. Wound infection was more common in patients who experienced pelvic abscess. The majority of pouch failures secondary to pelvic abscess formation occurred within two years of ileal pouch-anal anastomosis. Daytime incontinence, the use of a protective pad, and the need for constipating or bulking medication were significantly more common among patients who had an abscess but kept their reservoir. Ability to perform work and domestic activities and to undertake recreational activities were significantly more restricted among these patients.


CONCLUSIONS
Pouch failure occurs in one-fourth of patients who retain their pouch despite pelvic abscess after ileal pouch-anal anasto mosis. Among patients who retain their pouch despite postoperative pelvic abscess, functional outcome and quality of life are significantly poorer than in patients in whom no sepsis occurred.
Farouk
R
R
Division of Colon and Rectal Surgery, Mayo Medical Foundation, Rochester, Minnesota 55905, USA.
Dozois
R R
RR
Pemberton
J H
JH
Larson
D
D
D000038:Abscess / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010388:Pelvis; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome