Association of decreased perfusion of the ileoanal pouch mucosa with early postoperative pouchitis and local septic complications.
BACKGROUND
After ileoanal pouch operation, 5% to 40% of patients with ulcerative colitis and 2% to 8% of patients with familial adenomatous polyposis develop pouchitis. Seven percent to 32% of all patients have local septic complications. Pouch ischemia is discussed as a pathophysiologic factor. Tonometry is a minimally invasive method for estimating intramucosal pH (pHi), with a decreased pHi showing intramucosal acidosis characteristic of hypoperfusion.


OBJECTIVE
Decreased perfusion of the iloanal pouch measured by pHi is associated with local septic complications and the development of pouchitis.


METHODS
Prospective cohort study.


METHODS
Surgical department of a university hospital.


METHODS
The pHi in the ileoanal pouch of 98 patients was measured directly after the pouch procedure and correlated to the clinical course. Endoscopic examination of the pouch with biopsy and blinded histologic assessment, including calculation of a histologic pouchitis score, were routinely performed 3 months postoperatively.


METHODS
Development of pouchitis and local septic complications in correlation to pHi.


RESULTS
A decreased pHi was statistically significantly associated with the development of pouchitis and the rate of local septic complications. All 3 patients with anastomotic stenosis had a pHi less than 7.00. The diagnosis of ulcerative colitis just failed in statistical significance as a risk factor for pouchitis. An increased body mass index just failed as a statistically significant risk factor for complications but was a risk factor for the development of acute pouchitis.


CONCLUSIONS
Pouch hypoperfusion is a risk factor for the development of pouchitis and local septic complications.
Kienle
P
P
Department of Surgery, University of Heidelberg, INF 110, D-69120 Heidelberg, Germany. Peter_Kienle@med.uni-heidelberg.de
Weitz
J
J
Reinshagen
S
S
Magener
A
A
Autschbach
F
F
Benner
A
A
Stern
J
J
Herfarth
C
C
D011125:Adenomatous Polyposis Coli / Q000503:physiopathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000098:blood supply / Q000473:pathology; D002648:Child; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D007082:Ileum / Q000098:blood supply / Q000473:pathology; D007413:Intestinal Mucosa / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019449:Pouchitis / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D011446:Prospective Studies; D012039:Regional Blood Flow; D018805:Sepsis / Q000150:complications*