[Analysis of pouchitis after restorative proctocolectomy].
OBJECTIVE
Pouchitis is one of the most common and debilitating complications of a restorative proctocolectomy. We aimed to analyze the features of pouchitis after restorative proctocolecomy and to determine the risk factors related to its development.


METHODS
A study was undertaken in 169 patients who underwent total proctocolectomy with ileal pouch-anal anastomosis between July 1989 and December 2003. Pouchitis was defined as change of bowel habit, change in stool consistency, hematochezia or abdominal pain, febrile sensation and/or low-grade fever improved by metronidazole or ciprofloxacin without evidence of infectious disease and sphincter damage.


RESULTS
Among the 169 patients, patients with ulcerative colitis were 64, familial and attenuated adenomatous polyposis 44, Crohn's disease 2, and synchronous or hereditary non-polyposis colorectal cancer were 59 cases. Overall, pouchitis occurred in 15.9% of the patients. The incidence was 37.5% in ulcerative colitis, 1% in non-ulcerative colitis, and 50% in Crohn's disease. In ulcerative colitis group, most of the pouchitis (60.9%) occurred within 6 months after the operation and the remainder experienced the first attack within 1 year after operation. Three patients progressed to chronic pouchitis. There was no association between pouchitis rate and sex, history of smoking, steroid use, temporary ileostomy construction, involvement of appendix or proximal colon, and evidence of indeterminate colitis. Only age was significantly related to the occurrence of pouchitis.


CONCLUSIONS
Pouchitis developed exclusively in ulcerative colitis than other disease groups. Pouchitis occurred most frequently within 6 months after the operation, therefore, it is important to investigate carefully during one year after the operation in patients with ulcerative colitis.
Park
In Ja
IJ
Departments of Surgery, University of Ulsan College of Medicine, and Colorectal Clinic, Asan Medical Center, Seoul, Korea.
Yu
Chang Sik
CS
Kim
Hee Cheol
HC
Jung
Young Hak
YH
Han
Kyong Rok
KR
Yang
Suk Kyun
SK
Kim
Jin Cheon
JC
D011125:Adenomatous Polyposis Coli / Q000150:complications; D000328:Adult; D003093:Colitis, Ulcerative / Q000150:complications; D015179:Colorectal Neoplasms / Q000150:complications; D003424:Crohn Disease / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000209:etiology*; D012307:Risk Factors