- Ileo-anal pouch
The ileal pouch-anal anastomosis (IPAA), also known as an ileo-anal pouch, restorative proctocolectomy, ileal-anal pullthrough, or sometimes referred to as a j-pouch, s-pouch, w-pouch or an internal pouch, is an internal reservoir; usually situated where the rectum would normally be. It is formed by folding loops of small intestine (the
ileum) back on themselves and stitching or stapling them together. The internal walls are then removed thus forming a reservoir. The reservoir is then stitched or stapled into the perineum where the rectum was.
Reasons for pouch construction
Ileo-anal pouches are constructed for people who have had their large intestine surgically removed due to disease or injury. Diseases and conditions of the
large intestinewhich may require surgical removal include:
Familial adenomatous polyposis
There is debate about whether patients suffering from
Crohn's diseaseare suitable candidates for an ileo-anal pouch due to the risk of the disease occurring in the pouch, which could make matters even worse. An alternative to an ileo-anal pouch is an ileostomy.
In some cases where the pouch was formed as a result of colitis, inflammation can return to the pouch in a similar way to the original inflammation in the colon. This is known as
The surgical procedure for forming an ileo-anal pouch was developed as an alternative to the
ileostomywhere, in the absence of a colon, intestinal waste is emptied into a bag attached to the abdomen.This work was pioneered by Sir Alan Parks at St. Mark's Hospital in London in the early 1980's, the pouch was known as Parks' Pouch.
The entire procedure can be performed in one operation, but is usually split into two or three. When done as a two-step, the first operation involves a
colectomy(removal of the large intestine), and fashioning of the pouch. The patient is given a temporary defunctioning ileostomy(also known as a "loop ileostomy"). After a period of usually 3-6 months the second step (sometimes called the "takedown") is performed, in which the ileostomy is reversed. The reason for the temporary ileostomy is to allow the newly constructed pouch to fully heal without waste passing through it, thus avoiding infection.
Some surgeons prefer to perform a "subtotal colectomy" (removing all the colon except the
rectum), since removal of the rectum can lead to complications with the anal sphincters. When a colectomy is performed as an emergency, and/or when the patient is extremely ill, the colectomy and pouch construction are performed in separate stages.
Because the ileo-anal pouch is considerably smaller a reservoir than the colon, patients tend to have more frequent bowel motions; typically 6-8 times a day. Also because the
ileumdoes not absorb as much water as the colon, the stools tend to be less formed, and sometimes fluid. Immediately after the surgery is complete, the patient tends to pass liquid stool with frequent urgency, but this eventually settles down and the normal pouch output is described to be of a consistency similar to porridge. People who find that the consistency remains loose and/or who are experience motions too frequently usually take loperamideor codeine phosphateto thicken the stool and slow the bowel movement.
Because the ileum does not absorb as much of the
gastric acidproduced by the stomachas the colon did, pouch output also tends to burn the anal region slightly, and many patients find it helpful to wash the area regularly, sometimes using protective barrier cream.
Because more water is lost through pouch output, patients can get dehydrated easily and can also suffer salt deficiency. For this reason, some are encouraged to add extra salt to meals. Persistent dehydration is often supplemented with an electrolyte mix drink.
Many patients choose to eat more white carbohydrates, because this thickens the pouch output and reduces the risk of dehydration or the aforementioned burning of the anal region. It is also common among pouch-owners to eat little and often, or "graze", rather than having three large meals a day. Some patients avoid eating much after 6-7pm to avoid having to get up during the night.
Immediately after surgery, patients are encouraged to eat low fibre, high protein / carbohydrate meals, but after the pouch function has settled, most are able to reintroduce a fully varied diet. There are some foods that are known to irritate the pouch, however, and though they may be introduced carefully, are best avoided immediately following surgery.
* Increased stool output can be caused by
fibrousfoods (such as pulses, green leaves, raw vegetablesetc.) and also by spicy foods, alcohol and caffeine.
* Anal irritation can be caused by nuts, seeds, citric acid, raw fruit and spicy food.
* Increased wind can be caused by fizzy drinks, milk, beer, broccoli, cauliflower, sprouts, cabbage etc.
* Increased odour can be caused by foods such as fish, onions, garlic and eggs.
* [http://www.redliongroup.org Red Lion Group]
* [http://www.j-pouch.org The J-Pouch Group]
* [http://www.iasupport.org IA - The Ileostomy and Internal Pouch Support Group]
* [http://www.stmarkshospital.org.uk/uploads/docs/patientinformationleaflets/Ulcerative%20Colitis%20a%20surgical%20guide%20for%20patients.pdf Ulcerative Colitis: A Surgical Guide for Patients]
* [http://www.stmarkshospital.org.uk/uploads/docs/patientinformationleaflets/7bce6eff049945f7ae93c43f68f1ce51.pdf "Healthy Eathing for People with Pouches"]
Wikimedia Foundation. 2010.
Look at other dictionaries:
Reservoir ileo-anal — Réservoir iléo anal Un réservoir iléo anal, parfois appelé poche en J , poche en S , poche en W ou réservoir pelvien, est un réservoir interne, habituellement situé là où se trouve normalement le rectum et dont la fonction est de remplacer ce… … Wikipédia en Français
Réservoir iléo-anal — Un réservoir iléo anal, parfois appelé poche en J , poche en S , poche en W ou réservoir pelvien, est un réservoir interne, habituellement situé là où se trouve normalement le rectum et dont la fonction est de remplacer ce dernier. Le réservoir… … Wikipédia en Français
Pouch — may refer to:* Pouch (marsupial) used by female marsupials to rear their young through early infancy * Ileo anal pouch, an internal reservoir formed by connecting the end of the small intestine (the ileum) to the rectum * a Bag * Pouch, Germany a … Wikipedia
Ileostomy — Interventions infobox Name = PAGENAME ICD10 = ICD9 = 46.2 MeshID = D007081 OtherCodes = An ileostomy is a stoma that has been constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin. Intestinal… … Wikipedia
Colostomy — Not to be confused with corpus callosotomy. Colostomy Intervention Line drawing showing a permanent colostomy for rectal cancer. ICD 9 CM … Wikipedia
Ulcerative colitis — Classification and external resources Endoscopic image of a bowel section known as the sigmoid colon afflicted with ulcerative colitis. The internal surface of the colon is blotchy and broken in places … Wikipedia
Colonoscopy — Intervention ICD 9 CM 45.23 MeSH … Wikipedia
Familial adenomatous polyposis — Classification and external resources Endoscopic image of sigmoid colon of patient with familial adenomatous polyposis. ICD 10 C … Wikipedia
Eric Davis (baseball) — Infobox MLB retired name=Eric Davis position=Outfielder bats=Right throws=Right birthdate=birth date and age|1962|5|29 Los Angeles, California debutdate=May 19 debutyear=by|1984 debutteam=Cincinnati Reds finaldate=October 7 finalyear=by|2001… … Wikipedia
Ileostomie — Iléostomie Iléostomie CIM 10 : Une iléostomie est une stomie qui permet de relier l iléon vers l extérieur à travers la paroi de l abdomen par un acte chirurgical. Ainsi, le transit intestinal est dérivé directement de l iléon vers l extérieur et … Wikipédia en Français