title: Ileal pouch prolapse: prevalence, management, and outcomes.
abstract: 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.
authors.affiliation: Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A30, Cleveland, OH 44195, USA.
authors.forename: Myles R
authors.initials: MR
authors.lastname: Joyce
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
authors.forename: Tracy T
authors.initials: TT
authors.lastname: Hull
authors.forename: James
authors.initials: J
authors.lastname: Church
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Isabella
authors.initials: I
authors.lastname: Mor
authors.forename: Lei
authors.initials: L
authors.lastname: Lian
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
mesh_terms: 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
references.citation: Ann Surg. 2008 Oct;248(4):608-16
references.pmid: 18936574
references.citation: Clin Gastroenterol Hepatol. 2008 Feb;6(2):145-58; quiz 124
references.pmid: 18237865
references.citation: Int J Colorectal Dis. 2005 Nov;20(6):553-4
references.pmid: 15657695
references.citation: Ann Surg. 1995 Aug;222(2):120-7
references.pmid: 7639579
references.citation: Surgery. 2002 Oct;132(4):655-61; discussion 661-2
references.pmid: 12407350
references.citation: Dis Colon Rectum. 2004 Jun;47(6):885-8
references.pmid: 15054682
references.citation: Dis Colon Rectum. 2009 Feb;52(2):198-204
references.pmid: 19279412
references.citation: Ann Surg. 2003 Sep;238(3):433-41; discussion 442-5
references.pmid: 14501509
references.citation: Br Med J. 1978 Jul 8;2(6130):85-8
references.pmid: 667572