Department of Surgery, AmsterdamUniversity Medical Center, Amsterdam, the Netherlands.
Department of Gastroenterology and Hepatology, AmsterdamUniversity Medical Center, Amsterdam, the Netherlands.
Inflamm Bowel Dis. 2024 Oct 3;30(10):1635-1641. doi: 10.1093/ibd/izad228.
Approximately 1 in 10 patients with an ileal pouch-anal anastomosis is diagnosed with Crohn's disease of the pouch (CDP). However, this diagnosis may be established inappropriately, as alternative underlying causes necessitating an alternative treatment approach, such as long-term surgical sequelae, may mimic CDP. In this study, we aimed to identify patients diagnosed with and treated for CDP with a (concurrent) alternative diagnosis.
Ulcerative colitis and inflammatory bowel disease unclassified patients who underwent ileal pouch-anal anastomosis surgery in a tertiary center between 1990 and 2017 were retrospectively reviewed. Patients with a postoperative diagnosis of CDP for which medical treatment was initiated were identified. Presence of pouchitis, prepouch ileitis, stricture, and fistulas was assessed and histopathological reports were evaluated. Thereafter, cross-sectional images of the pouch in CDP patients were re-evaluated to identify potential long-term surgical sequelae (ie, chronic presacral sinus or perianastomotic fistulas).
After a median postoperative follow-up of 6.2 (interquartile range, 2.3-13.5) years, 47 (10%) of 481 patients were diagnosed with CDP. CDP patients had pouchitis (n = 38 [81%]), prepouch ileitis (n = 34 [74%]), strictures (n = 17 [36%]), fistulas (n = 15 [32%]), or a combination. Multiple granulomas were found in 1 pouch resection specimen. Re-evaluation of 40 (85%) patients who underwent magnetic resonance imaging revealed presence of long-term surgical sequelae in 17 (43%) patients. Six (15%) patients demonstrated isolated nonanastomotic fistulas.
Re-evaluation of cross-sectional imaging of the pouch revealed that potential alternative causes were found in nearly half of CDP patients. Cross-sectional imaging is therefore recommended early in the diagnostic pathway to exclude an alternative diagnosis.
约每 10 个接受回肠贮袋肛门吻合术的患者中就有 1 个被诊断为贮袋克罗恩病（CDP）。然而，这种诊断可能并不恰当，因为需要采取不同治疗方法的其他潜在病因，如长期手术后遗症，可能与 CDP 相似。在这项研究中，我们旨在确定诊断为 CDP 并接受治疗的患者中存在（同时存在）其他潜在诊断的情况。
回顾性分析了 1990 年至 2017 年在一家三级中心接受回肠贮袋肛门吻合术的溃疡性结肠炎和未分类炎症性肠病患者。确定术后诊断为 CDP 并开始接受药物治疗的患者。评估贮袋炎、贮袋前回肠炎、狭窄和瘘管的存在情况，并评估组织病理学报告。然后，重新评估 CDP 患者贮袋的横断面图像，以识别潜在的长期手术后遗症（即慢性直肠前窦或吻合口瘘）。
在中位术后随访 6.2 年（四分位距，2.3-13.5 年）后，47 例（10%）481 例患者被诊断为 CDP。CDP 患者存在贮袋炎（n=38 [81%]）、贮袋前回肠炎（n=34 [74%]）、狭窄（n=17 [36%]）、瘘管（n=15 [32%]）或以上几种情况的组合。1 个贮袋切除标本中发现多个肉芽肿。对 40 例（85%）接受磁共振成像检查的患者进行重新评估，发现 17 例（43%）患者存在长期手术后遗症。6 例（15%）患者表现为孤立性非吻合口瘘。
对贮袋的横断面图像进行重新评估发现，近一半的 CDP 患者存在潜在的其他病因。因此，建议在诊断途径早期进行横断面成像检查以排除其他诊断。
