The final diagnosis in pouch patients for presumed ulcerative colitis may change to Crohn's disease: patients should be warned of the consequences.
BACKGROUND
The ileal pouch is usually the procedure of choice in the surgical management of Ulcerative Colitis (UC), but pouch surgery has a high complication and failure rate in Crohn's Disease (CD).


METHODS
This study is a review of 222 consecutive patients with an initial diagnosis of UC and 3 with CD, treated by ileal pouch anal anastomosis.


RESULTS
Only 3 of 225 patients treated by ileal pouch anal anastomosis had a preoperative diagnosis of CD. At the time of follow-up the diagnosis was 23 CD and 202 UC (median follow-up 118.6 months for CD and 91.3 months for UC). 10 of 23 patients with CD had an 1 stage proctocolectomy and pouch and 13 had an initial colectomy. The following were significantly more common in CD than UC: ileo-anal sepsis (30% v 12%: p = 0.028) and pouchitis (65% v 32%: p = 0.0016). The pouch excision rate was 47.8% in CD and 10.9% in UC (p). Uniquely we found that 8/11 patients with CD had perineal sinus after pouch excision compared with only 1/22 in those with UC (p). The median functional score (scale 0-12), in those with intact pouches, was the same in CD and UC: 4 and 3 respectively.


CONCLUSIONS
Our findings show that ileal pouch anal anastomosis is a satisfactory procedure for UC but that the diagnosis had to be changed to CD in 20 of 222 cases. Thus patients should be warned about a 48% failure rate and a high incidence of complications if CD declares itself during follow-up but Crohn's patients who retain their pouch have functional results that are indistinguishable from UC.
Keighley
M R
MR
University Department of Surgery Queen Elisabeth Hospital Edgbaston, Birmingham, UK.
D000293:Adolescent; D000328:Adult; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery*; D003424:Crohn Disease / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*