Small intestine & ampulla
Inflammatory disorders
Ileal pouch / pouchitis
Author: Hanni Gulwani, M.B.B.S.
Last author update: 1 August 2012
Last staff update: 14 September 2020
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: Ileal pouch pouchitis small bowel[TIAB]
Table of Contents
Definition / general | Pouchitis | Treatment | Microscopic (histologic) description | Microscopic (histologic) imagesCite this page: Gulwani H. Ileal pouch / pouchitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/smallbowelilealpouch.html. Accessed April 18th, 2024.
Definition / general
- Pouch is formed from connecting loops of terminal ileum for patients requiring total colectomy; used to create continence in an ileostomy or to preserve anal sphincter function
- Pouches are contraindicated in Crohn's disease because they are associated with fistulas and abscess
- Complications: fistula, obstruction, incontinence, leaks, pouchitis
Pouchitis
- Incidence 8 - 46%
- Some cases are due to initially undiagnosed Crohn's disease
- Nausea, vomiting, malaise, fever, cramping
- Increased ileal stool that is bloody, watery, foul smelling
- Often with altered bacteria
Treatment
- Antibiotics, pouch excision
Microscopic (histologic) description
- Decreased epithelial cell mucin, few / no lymphoid follicles
- Ulcers with granulation tissue, cryptitis, crypt abscesses and patchy neutrophils
- Rarely dysplasia
- CD10 staining confirms biopsy site - terminal ileum (CD10+) versus colon (CD10-), although negative staining also occurs in active enteritis (Mod Pathol 2011;24:1627)
Microscopic (histologic) images
Contributed by Hanni Gulwani, M.D.
CMV pouchitis: biopsy of postcolectomy pouch in 38 year old man with ulcerative colitis
