Crohn's Disease Surgery - Pelvic Pouch Surgery

Ulcerative colitis does not recur once the rectum and colon have been removed, but Crohn's disease can come back in the pouch and in the small intestine above the pouch. This frequently leads to poor pouch function, medical complications, and a very unhappy patient who has gone through several operations with the expectation of being 'cured'.

 

 

Although pelvic pouch procedures are, in most circumstances, not offered to patients with known Crohn's disease, there are some patients who, despite extensive examination and investigation prior to surgery, are thought to have ulcerative colitis but subsequently are discovered to have Crohn's disease. This can occur once the entire colon has been removed and examined under a microscope by a pathologist or after being followed for many years after surgery and found ultimately to develop features of Crohn's disease, such as ulcers in the small intestine above the pouch.

 

In these cases, the patient with Crohn's disease is left with a pelvic pouch. Antibiotics, steroids, immunosuppressants, and especially infliximab have been found to be quite helpful in this setting, although the experience is still rather limited. A significant proportion of patients with Crohn's disease and a pelvic pouch — somewhere around 1 in 4 — will end up requiring further surgery and very possibly surgical removal of the pouch, with the creation of a permanent ileostomy.

 

 

In some cases when IBD involves only the colon, Crohn's disease cannot be differentiated from ulcerative colitis, even when the entire colon has been removed and examined by a pathologist. In that situation, called indeterminate colitis, the pelvic pouch procedure may be offered to patients with the understanding that some will ultimately turn out to have Crohn's disease, with a higher chance of failure of the pouch procedure. However, when all patients with indeterminate colitis undergoing the pelvic pouch procedure are compared to patients with ulcerative colitis, patients with indeterminate colitis have only a slightly higher risk of pouch failure.