title: The pediatric pouch in inflammatory bowel disease: a primer for the gastroenterologist.
abstract: Pediatric severe ulcerative colitis that is resistant to current medical treatment can successfully be managed surgically with a colectomy, ileal pouch creation and pouch-anal anastomosis. Key issues that should be considered and discussed before the pouch option can be offered include alternative surgical procedures, pouch function expectations, risk of surgical leak, pelvic sepsis, anastomotic strictures, acute and chronic pouch inflammation, Crohn's disease of the pouch and risk of reduced fertility for females. A long-term risk is malignancy of the residual colonic tissue. The decision to proceed with a pouch or not poses a substantial emotional burden to the child and family. Despite the risk of surgical complications and pouch inflammatory and functional challenges, the overwhelming majority of children and their families are satisfied with their pouch surgery outcomes. Further study is needed to assess preoperative risk predictors, prevention and treatment of complications.
authors: Inflammatory Bowel Disease Program, Seattle Children's Hospital, University of Washington, W7830, Gastroenterology, 4800 Sand Point Way NE, Seattle, WA 98105, USA. ghassan.wahbeh@seattlechildrens.org
authors: Ghassan T
authors: GT
authors: Wahbeh
authors: David L
authors: DL
authors: Suskind
authors: Scott D
authors: SD
authors: Lee
authors: John T
authors: JT
authors: Waldhausen
authors: Karen F
authors: KF
authors: Murray
mesh_terms: D000293:Adolescent; D002648:Child; D039021:Colonic Pouches; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D007249:Inflammation / Q000453:epidemiology; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D018570:Risk Assessment; D018805:Sepsis / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult