Ileal pouch prolapse: prevalence, management, and outcomes.
OBJECTIVE
The study aim is to review the prevalence, management, and outcomes for patients diagnosed with ileal pouch prolapse after restorative proctocolectomy.


METHODS
Patients were identified retrospectively from a prospectively maintained pouch database. Parameters analyzed included presenting symptoms, indications for pouch surgery, type of ileal pouch-anal anastomosis, treatment modalities, and outcomes.


RESULTS
Of 3,176 patients who underwent ileal pouch surgery, 11 were diagnosed with pouch prolapse (0.3%). Seven had full-thickness prolapse and four mucosal prolapse. Six were male, and five were female. Indication for index surgery was ulcerative colitis (nine patients), familial adenomatous polyposis (one patient), and colonic inertia (one patient). Median age at pouch prolapse was 34 years. Median time from index surgery to prolapse diagnosis was 2 years. Two patients with mucosal prolapse responded to conservative management; two required mucosal excisions. An abdominal approach was successful in four out of seven patients with full thickness prolapse. The three failures subsequently underwent continent ileostomy formation and prompted us to add biological mesh to future pouchpexy repairs.


CONCLUSIONS
Pouch prolapse is rare, and there are no obvious predisposing factors. Mucosal prolapse may be treated by stool bulking or a local perineal procedure. Full thickness prolapse requires definitive surgery and is associated with risk of pouch loss.
Joyce
Myles R
MR
Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A30, Cleveland, OH 44195, USA.
Fazio
Victor W
VW
Hull
Tracy T
TT
Church
James
J
Kiran
Ravi P
RP
Mor
Isabella
I
Lian
Lei
L
Shen
Bo
B
Remzi
Feza H
FH
D000328:Adult; D003108:Colonic Diseases / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D008297:Male; D015995:Prevalence; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011391:Prolapse; D016896:Treatment Outcome
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