Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Colorectal Surgery, Changhai Hospital, Shanghai, China.
Int J Colorectal Dis. 2020 Apr;35(4):665-674. doi: 10.1007/s00384-019-03469-x. Epub 2020 Feb 4.
Pouch prolapse is a rare pouch complication which often leads to pouch failure in inflammatory bowel disease (IBD) patients. Its exact cause remains unknown. Floppy pouch complex (FPC) was defined as the presence of any one of the following pouch disorders: pouch prolapse, afferent limb syndrome (ALS), redundant loop, and pouch folding. We aimed to explore the role of peripouch fat area in the occurrence of pouch prolapse and FPC.
Pouch patients with available pouchoscopy and abdominal CT scans who were followed up between 2011 and 2017 in Cleveland Clinic were reviewed. Peripouch fat was measured on CT images.
Of the 93 included patients, 31 were females; 87 had J pouches and 6 had S pouches. The median duration of pouch was 8.0 (interquartile range [IQR] 5.0-16.5) years. A total of 18 cases (19.4%, 18/93) were identified as FPC, including 12 pouch prolapse, 5 ALS, 1 redundant loop, and 3 pouch folding. Patients with pouch prolapse had lower peripouch fat area (13.6 (9.3-18.5) vs. 27.6 (11.0-46.2)cm, P = 0.022) than those without. Patients with FPC had lower peripouch fat area (15.4 (11.4-20.6) vs. 27.6 (11.0-46.9)cm, P = 0.040) than those without. Univariate and multivariate analyses demonstrated that lower peripouch fat area, lower weight, and family history of IBD were independent predictors of pouch prolapse and FPC.
A lower peripouch fat area was observed in inflammatory bowel disease patients with pouch prolapse and FPC. Longitudinal studies are needed to further elucidate the role of peripouch fat in the pathogenesis of pouch prolapse and FPC.
pouch 脱垂是 pouch 并发症中一种罕见的疾病，它常常导致炎症性肠病（IBD）患者 pouch 功能丧失。其确切病因尚不清楚。“松弛 pouch 综合征（FPC）”定义为存在以下 pouch 疾病之一：pouch 脱垂、输入襻综合征（ALS）、冗余袢和 pouch 折叠。我们旨在探讨 pouch 周围脂肪区在 pouch 脱垂和 FPC 发生中的作用。
回顾 2011 年至 2017 年在克利夫兰诊所接受 pouchoscopy 和腹部 CT 扫描随访的 pouch 患者。在 CT 图像上测量 pouch 周围脂肪。
93 例患者中，31 例为女性；87 例为 J pouch，6 例为 S pouch。 pouch 的中位时间为 8.0（四分位间距 [IQR] 5.0-16.5）年。共有 18 例（19.4%，18/93）被诊断为 FPC，包括 12 例 pouch 脱垂、5 例 ALS、1 例冗余袢和 3 例 pouch 折叠。pouch 脱垂患者的 pouch 周围脂肪面积较小（13.6（9.3-18.5）vs. 27.6（11.0-46.2）cm，P=0.022）。患有 FPC 的患者 pouch 周围脂肪面积较小（15.4（11.4-20.6）vs. 27.6（11.0-46.9）cm，P=0.040）。单因素和多因素分析表明，较低的 pouch 周围脂肪面积、较低的体重和 IBD 家族史是 pouch 脱垂和 FPC 的独立预测因素。
在 pouch 脱垂和 FPC 的 IBD 患者中观察到 pouch 周围脂肪面积较低。需要进行纵向研究以进一步阐明 pouch 周围脂肪在 pouch 脱垂和 FPC 发病机制中的作用。
