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DOI:10.2214/AJR.05.1019
AJR 2006; 187:W386-W391
© American Roentgen Ray Society

Clinical Observations

MRI of Complicated Pouchitis

Rohini N. Nadgir1, Jorge A. Soto1, Klea Dendrinos2, Brian C. Lucey1, James M. Becker3 and Francis A. Farraye2

1 Department of Radiology, Boston University Medical Center, 88 E Newton St., 2nd Floor, Boston, MA 02118.
2 Department of Gastroenterology, Boston University Medical Center, Boston, MA 02118.
3 Department of Surgery, Boston University Medical Center, Boston, MA 02118.

OBJECTIVE. The purpose of this study is to assess the ability of MRI to identify the presence of inflammation related to the pouch reservoir in symptomatic patients with an ileal pouch-anal anastomosis who present with clinically suspected complicated pouchitis.

CONCLUSION. Initial results suggest that MRI should be considered in patients who have undergone ileal pouch-anal anastomosis and present a clinical impression of complicated pouchitis. MRI showed abnormalities consistent with complicated pouchitis in seven of nine examinations, with findings including pouch wall thickening, abnormal wall enhancement, peripouch fluid collection, sinus and fistula tract formation, lymphadenopathy, and peripouch stranding and fatty proliferation. MRI findings of complicated pouchitis should raise the suspicion of Crohn's disease and should prompt further investigation.

Keywords: gastrointestinal radiology • inflammatory bowel disease • MRI • pelvic imaging


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