Tonolini Massimo, Campari Alessandro, Bianco Roberto
Department of Radiology, Luigi Sacco University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
Abdom Imaging. 2011 Dec;36(6):698-706. doi: 10.1007/s00261-011-9693-1.
Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the established surgical therapy for familial adenomatous polyposis (FAP) and refractory ulcerative colitis (UC). Despite general patient satisfaction with preserved fecal continence, this procedure is associated with a significant long-term morbidity approaching 70% after 10 years, and with a non-negligible rate of pouch failure leading to removal and permanent ileostomy. Following a concise description of the surgical technique, the normal imaging appearance of the ileal "pouch" reservoir at pelvic CT and MRI is explained. Since awareness of their imaging appearances is needed for a correct diagnosis, we discuss and illustrate common and unusual pouch-related complications, including pouchitis and irritable pouch disease; anastomotic leakages and pelvic abscess collections; fistulas involving the ano-perianal region, urinary bladder, vagina, perineal skin, and subcutaneous planes; anal stenosis and small-bowel obstruction. In our experience, pelvic contrast-enhanced MRI has proven invaluable for the diagnostic assessment of patients with suspected pouch-related complications, allowing differentiation of uncomplicated pouchitis from pelvic sepsis, the latter requiring aggressive therapy and possible even in patients with normal endoscopic findings.
全直肠系膜切除术加回肠储袋肛管吻合术（IPAA）是家族性腺瘤性息肉病（FAP）和难治性溃疡性结肠炎（UC）既定的外科治疗方法。尽管患者总体上对保留的大便失禁情况感到满意，但该手术与显著的长期发病率相关，10年后接近70%，且储袋失败率不可忽视，会导致储袋切除和永久性回肠造口术。在简要描述手术技术之后，解释了盆腔CT和MRI上回肠“储袋”的正常影像学表现。由于正确诊断需要了解其影像学表现，我们讨论并举例说明常见和不常见的与储袋相关的并发症，包括储袋炎和易激储袋病；吻合口漏和盆腔脓肿；累及肛门周围区域、膀胱、阴道、会阴皮肤和皮下平面的瘘管；肛门狭窄和小肠梗阻。根据我们的经验，盆腔增强MRI已被证明对疑似与储袋相关并发症患者的诊断评估非常有价值，能够区分单纯性储袋炎和盆腔脓毒症，后者需要积极治疗，甚至在内镜检查结果正常的患者中也可能发生。
