Division of Colorectal Surgery, Department of Surgery, Columbia University Medical Center, Herbert Irving Pavilion, 161 Ft. Washington Ave., 8th Floor, Room 8-836, New York, NY, 10032, USA.
Abdom Radiol (NY). 2023 Sep;48(9):2930-2934. doi: 10.1007/s00261-022-03721-z. Epub 2023 Feb 28.
For the last 40 years, the ileal pouch-anal anastomosis has been used in patients with ulcerative colitis, familial adenomatous polyposis, and occasionally severe constipation to reconstruct the gastrointestinal tract after proctocolectomy. Although the procedure has generally been successful in helping patients avoid an ileostomy, it has come with its own set of problems. These include complications of the surgery such as fistulas and bowel obstruction, persistent inflammation of the pouch known as pouchitis, and functional problems related to the lack of expulsive peristalsis in the pouch. It is this last group of problems that is exacerbated by a poor diet, ill-advised anti-diarrheal medications, anal stenosis and pouch twists. As a consequence, patients with pouch problems are frequently referred for radiologic evaluation, with pouchography, defecation studies, and small bowel imaging commonly requested. In this review, the basic anatomy and physiology of the ileal pouch are discussed to provide a logical baseline against which to measure the anatomy of pouches and its relationship to the symptoms of pouch dysfunction.
在过去的 40 年里，回肠贮袋-肛管吻合术已被用于溃疡性结肠炎、家族性腺瘤性息肉病以及偶尔严重便秘的患者，以在直肠结肠切除术后重建胃肠道。尽管该手术通常有助于患者避免肠造口术，但它也带来了一系列自身问题。这些问题包括手术并发症，如瘘管和肠梗阻、称为贮袋炎的贮袋持续炎症以及与贮袋中缺乏推进性蠕动相关的功能问题。正是最后一组问题因不良饮食、不当的止泻药物、肛门狭窄和贮袋扭曲而加重。因此，有贮袋问题的患者经常需要进行放射学评估，通常需要进行贮袋造影、排粪研究和小肠成像。在这篇综述中，讨论了回肠贮袋的基本解剖和生理学，为测量贮袋的解剖结构及其与贮袋功能障碍症状的关系提供了一个合理的基线。
