Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Dis Colon Rectum. 2011 Apr;54(4):454-9. doi: 10.1007/DCR.0b013e31820481be.
Diagnosis and management of leak from the tip of the J-pouch after IPAA has not been systematically studied.
The aim of this study is to report our experience in the diagnosis and management of these leaks following primary IPAA.
This study is a retrospective review of prospectively gathered data.
Data were obtained from a prospectively maintained single-institution pelvic pouch database.
Included in this study were patients with a leak from the tip of the J-pouch after primary IPAA.
The main measures of outcomes after salvage surgery were pouch failure, pouch function, and quality of life.
There were 27 (14 male) patients. Median age was 37 years (range, 20-73). Underlying disease in these patients was ulcerative colitis in 22 patients. Predominant symptoms were abdominal pain (n = 15) and fever (n = 5). Twenty patients had either a pelvic abscess detected by CT or MRI or a leak demonstrated at gastrografin enema or pouchoscopy. In 6 patients, the diagnosis was only made at salvage surgery. In 1 patient, the leak-associated abscess was detected during emergent laparotomy for acute peritonitis before salvage surgery. Of 27 patients, 1 had successful CT-guided drainage without the need for further surgery. Another patient had pouch resection with end ileostomy. Salvage surgery was performed in 25 patients by means of pouch repair (n = 23) and new pouch creation (n = 2); 8 patients had a repeat anastomosis. Median time from primary IPAA to salvage surgery was 0.9 years (0.13-9.8). Twenty-four patients with salvage surgery have a functioning pouch after a mean follow-up of 3.2 ± 1.9 years.
: The study was limited by its retrospective nature.
Leak from the tip of the J-pouch is indolent and diagnosis can be difficult. Satisfactory outcomes in terms of pouch retention may be expected after appropriate surgical management.
J 袋尖端漏的诊断和处理尚未得到系统研究。
本研究旨在报告我们在原发性 IPAA 后处理这些漏的经验。
这是一项前瞻性收集数据的回顾性研究。
数据来自前瞻性维护的单机构盆腔袋数据库。
本研究纳入了原发性 IPAA 后 J 袋尖端漏的患者。
挽救手术后的主要结果是袋失败、袋功能和生活质量。
共有 27 名（14 名男性）患者。中位年龄为 37 岁（范围，20-73 岁）。这些患者的基础疾病为溃疡性结肠炎 22 例。主要症状为腹痛（n = 15）和发热（n = 5）。20 例患者通过 CT 或 MRI 发现盆腔脓肿，或通过胃造影或袋镜检查发现漏。在 6 例患者中，仅在挽救手术时作出诊断。在 1 例患者中，在挽救手术前急性腹膜炎的紧急剖腹探查中发现与漏相关的脓肿。27 例患者中，1 例经 CT 引导引流成功，无需进一步手术。另 1 例患者行袋切除和回肠造口术。25 例患者行挽救手术，其中 23 例行袋修补，2 例行新袋成形术；8 例行再次吻合术。原发性 IPAA 至挽救手术的中位时间为 0.9 年（0.13-9.8）。24 例接受挽救手术的患者在平均 3.2 ± 1.9 年的随访后保留了功能袋。
研究受到其回顾性的限制。
J 袋尖端漏是惰性的，诊断可能具有挑战性。适当的手术处理后，可能会获得满意的保留袋效果。
