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Radiology of Ileal Pouch–Anal Anastomosis Surgery

Richard E. Seggerman1, Michael Y. Chen1, Gregory S. Waters2 and David J. Ott1

1 Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088.
2 Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, 27157.



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  		Fig. 1A. —Diverting loop ileostomy. Drawing shows how proximal limb is everted to create 2-cm spout (P). Distal limb (D) is adjacent to proximal limb.

 


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  		Fig. 1B. —Diverting loop ileostomy. Loop ileostomy in 35-year-old woman who underwent ileal pouch–anal anastomosis because of familial polyposis and colon cancer. CT scan shows proximal (arrow) and distal (arrowhead) limbs of loop ileostomy.

 


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  		Fig. 2. —33-year-old man who underwent subtotal proctocolectomy and ileal pouch–anal anastomosis. Radiograph of pelvis shows characteristic dual row of pouch staples (arrowheads) and circular ileal pouch–anal anastomosis staples (arrow).

 


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  		Fig. 3A. —Ileal pouch–anal anastomosis in 57-year-old man with ulcerative colitis. Anterior (A) and lateral (B) radiographs of ileoanal pouch show proximal limb (arrow, B) and blind ileal stump (arrowhead, B).

 


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  		Fig. 3B. —Ileal pouch–anal anastomosis in 57-year-old man with ulcerative colitis. Anterior (A) and lateral (B) radiographs of ileoanal pouch show proximal limb (arrow, B) and blind ileal stump (arrowhead, B).

 


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  		Fig. 3C. —Ileal pouch–anal anastomosis in 57-year-old man with ulcerative colitis. Line drawing of A shows that apex of ileal reservoir is brought down to anal area and anastomosed to dentate line mucosa (arrow).

 


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  		Fig. 4A. —Ileal pouch–anal anastomosis in 46-year-old woman who underwent proctocolectomy for familial polyposis and colon cancer. CT scan shows ileal pouch with air (arrow) in pouch before ileostomy (arrowhead) closure.

 


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  		Fig. 4B. —Ileal pouch–anal anastomosis in 46-year-old woman who underwent proctocolectomy for familial polyposis and colon cancer. CT scan shows ileal pouch (arrow) after ileostomy closure. Pouch was opacified with contrast material.

 


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  		Fig. 5A. —Abscess in 29-year-old woman with ulcerative colitis who underwent ileal pouch–anal anastomosis. CT scan (A) and cutaneous fistulogram (B) show abscess (A) with cutaneous fistula (arrowheads) and enteric fistula (arrows).

 


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  		Fig. 5B. —Abscess in 29-year-old woman with ulcerative colitis who underwent ileal pouch–anal anastomosis. CT scan (A) and cutaneous fistulogram (B) show abscess (A) with cutaneous fistula (arrowheads) and enteric fistula (arrows).

 


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  		Fig. 5C. —Abscess in 29-year-old woman with ulcerative colitis who underwent ileal pouch–anal anastomosis. Contrast enema shows contrast material filling pouch (P) and vagina (V), indicating pouch–vaginal fistula.

 


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  		Fig. 6A. —Ileal pouch–anal anastomotic stricture in 29-year-old woman with familial polyposis who underwent ileal pouch–anal anastomosis. Anteroposterior (A) and lateral (B) radiographs of contrast enema reveal ileal pouch–anal anastomotic stricture (arrows) that was subsequently successfully dilated during ileostomy takedown procedure.

 


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  		Fig. 6B. —Ileal pouch–anal anastomotic stricture in 29-year-old woman with familial polyposis who underwent ileal pouch–anal anastomosis. Anteroposterior (A) and lateral (B) radiographs of contrast enema reveal ileal pouch–anal anastomotic stricture (arrows) that was subsequently successfully dilated during ileostomy takedown procedure.

 

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