Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute-A31, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
Department of Colorectal Surgery, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA.
Int J Colorectal Dis. 2019 Jun;34(6):1061-1067. doi: 10.1007/s00384-019-03282-6. Epub 2019 Apr 11.
Restorative proctocolectomy with ileal pouch-anal anastomosis can be associated with a variety of complications, including floppy pouch complex (FPC). FPC is defined as the presence of pouch prolapse, afferent limb syndrome, enterocele, redundant loop, and folding pouch on pouchoscopy or contrasted pouchogram. The main symptoms of patients with FPC are dyschezia, incomplete evacuation, and bloating. The aims of the study were to evaluate the relative frequency of each disorder of FPC and to characterize its risk factors.
This case-control study included all eligible patients with FPC from our prospectively maintained, IRB-approved Pouchitis Registry from 2011 to 2017. The control group included the patients without any of the above conditions. Univariate and multivariate analyses were performed.
A total of 437 eligible patients were analyzed including 97 (22.2%) with FPC and 340 (77.8%) without FPC, 188 (43.0%) being female, 360 (82.4%) being Caucasians, and 66 (15.1%) having a family history of inflammatory bowel disease (IBD). There were 427 patients (97.7%) having J pouches and 10 (2.2%) having S pouches and the median duration from pouch construction to data sensor was 6.0 years (interquartile range 0.962-1.020). In the whole cohort, 64 (66.0%) patients had pouch prolapse, 38 (39.2%) patients had afferent limb syndrome, 10/42 (23.8%) patients had redundant loop, and 3/42 (7.1%) had folding pouch. In multivariable analysis, lower body weight (odds ratio [OR] 0.944; interquartile range; 95% confidence interval [CI] 0.913-0.976, P = 0.001) and the presence of family history of IBD (OR 4.098; 95% CI 1.301-12.905, P = 0.013) were associated with a higher risk of FPC.
We found that pouch prolapse and afferent limb syndrome are the most common forms of FPC. A lower body weight as well as family history of IBD was found to be risk factors for FPC. The findings will have implications in both diagnosis and investigation of etiopathogenesis of this group of challenging disorders.
直肠结肠切除并回肠储袋肛管吻合术可能会引起多种并发症，包括储袋脱垂综合征（FPC）。FPC 定义为在储袋内镜或对比储袋造影时存在储袋脱垂、输入襻综合征、内疝、冗余襻和折叠储袋。FPC 患者的主要症状为排便困难、不完全排空和腹胀。本研究的目的是评估 FPC 中每种疾病的相对频率，并对其危险因素进行特征描述。
本病例对照研究纳入了 2011 年至 2017 年我院前瞻性维护的经 IRB 批准的储袋炎登记处中所有符合条件的 FPC 患者。对照组纳入了无上述任何一种情况的患者。进行了单变量和多变量分析。
共分析了 437 名符合条件的患者，其中 97 名（22.2%）患有 FPC，340 名（77.8%）无 FPC，188 名（43.0%）为女性，360 名（82.4%）为白种人，66 名（15.1%）有炎症性肠病（IBD）家族史。427 名（97.7%）患者有 J 型储袋，10 名（2.2%）患者有 S 型储袋，从储袋构建到数据传感器的中位时间为 6.0 年（四分位距 0.962-1.020）。在整个队列中，64 名（66.0%）患者有储袋脱垂，38 名（39.2%）患者有输入襻综合征，10/42 名（23.8%）患者有冗余襻，3/42 名（7.1%）患者有折叠储袋。多变量分析显示，体重较低（比值比 [OR] 0.944；四分位距；95%置信区间 [CI] 0.913-0.976，P = 0.001）和 IBD 家族史（OR 4.098；95% CI 1.301-12.905，P = 0.013）与 FPC 的风险增加相关。
我们发现储袋脱垂和输入襻综合征是 FPC 最常见的形式。体重较低和 IBD 家族史是 FPC 的危险因素。这些发现将对这组具有挑战性疾病的诊断和发病机制的研究产生影响。
