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Pouchography, CT, and MRI Features of Ileal J Pouch-Anal Anastomosis

¹ All authors: Department of Radiology, Saint-Antoine Hospital, 184 rue du faubourg Saint-Antoine, Paris, France 75012.

View larger version (20K): [in a new window]   Fig. 1 —Drawing of J pouch-anal anastomosis. Ileal J pouch is created by folding 15 cm of terminal ileum back on itself. After anastomosis of opposite ileal loops in side-to-side fashion, anastomosis of ileal reservoir apex to anus along pectinate line is performed. Note that efferent limb of loop ileostomy is same portion of bowel as afferent limb of ileal J pouch. IPAA = ileal pouch-anal anastomosis.

View larger version (101K): [in a new window]   Fig. 2 —41-year-old man with ulcerative colitis who underwent total proctocolectomy and ileal J pouchanal anastomosis. Anteroposterior radiograph of contrast enema shows ileal J pouch (white arrow), dual row of pouch staples (gray arrowheads), and ileal pouch-anal anastomosis (white arrowheads). Proximal limb (gray arrow) and blind ileal stump (black arrow) are easily identified.

View larger version (136K): [in a new window]   Fig. 3A —Ileal pouch-anal anastomosis in 27-year-old woman with familial adenomatous polyposis. CT examination shows ileal pouch identified by row of staples (arrows) opposed 180x to each other.

View larger version (121K): [in a new window]   Fig. 3B —Ileal pouch-anal anastomosis in 27-year-old woman with familial adenomatous polyposis. Pouch-anal anastomosis (arrow) can also be identified on CT.

View larger version (143K): [in a new window]   Fig. 4A —MRI examination of 33-year-old woman with familial adenomatous polyposis who underwent proctocolectomy and ileal J pouch-anal anastomosis. Axial T2-weighted image. Pouch is identified by row of staples (arrows) presenting as small ferromagnetic artifacts on MRI (metallic signal).

View larger version (135K): [in a new window]   Fig. 4B —MRI examination of 33-year-old woman with familial adenomatous polyposis who underwent proctocolectomy and ileal J pouch-anal anastomosis. Sagittal T2-weighted image. Pouch (arrow) is identified by row of staples (arrows in A) presenting as small ferromagnetic artifacts on MRI (metallic signal). Pouch-anal anastomosis (arrowheads) can also be identified.

View larger version (112K): [in a new window]   Fig. 5A —Small-bowel obstruction in 22-year-old woman with familial adenomatous polyposis who underwent ileal J pouch-anal anastomosis. CT shows dilated small bowel (D), nondilated small bowel (ND), and transition area (arrows). Cause of obstruction was determined to be an adhesion.

View larger version (127K): [in a new window]   Fig. 5B —Small-bowel obstruction in 22-year-old woman with familial adenomatous polyposis who underwent ileal J pouch-anal anastomosis. Pouch is identified by row of staples (arrows). Note dilated small bowel in right iliac fossa (arrowheads).

View larger version (174K): [in a new window]   Fig. 6A —Pouchitis in 49-year-old woman with familial adenomatous polyposis who had episodes of pelvic pain, fever, and tenesmus. CT shows marked pouch wall thickening (arrows). Note pelvic desmoid tumor compressing pouch wall (arrowheads, B).

View larger version (158K): [in a new window]   Fig. 6B —Pouchitis in 49-year-old woman with familial adenomatous polyposis who had episodes of pelvic pain, fever, and tenesmus. CT shows marked pouch wall thickening (arrows). Note pelvic desmoid tumor compressing pouch wall (arrowheads, B).

View larger version (151K): [in a new window]   Fig. 7A —63-year-old woman with familial adenomatous polyposis who underwent ileal J pouch-anal anastomosis. CT examination with contrast enema shows anastomotic leakage (arrow) caused by anastomotic separation.

View larger version (161K): [in a new window]   Fig. 7B —63-year-old woman with familial adenomatous polyposis who underwent ileal J pouch-anal anastomosis. Note marked stranding of associated peripouch fat (arrowheads).

View larger version (160K): [in a new window]   Fig. 8A —36-year-old man with familial adenomatous polyposis who underwent ileal J pouch-anal anastomosis. CT examination with contrast enema shows pouch leakage (arrow) caused by pouch dehiscence. No staple is identified at leakage site.

View larger version (161K): [in a new window]   Fig. 8B —36-year-old man with familial adenomatous polyposis who underwent ileal J pouch-anal anastomosis. Pelvic abscess (arrowheads) complicates this leakage.

View larger version (115K): [in a new window]   Fig. 8C —36-year-old man with familial adenomatous polyposis who underwent ileal J pouch-anal anastomosis. Abscess was drained under CT guidance.

View larger version (129K): [in a new window]   Fig. 9 —Pouch-vaginal fistula in 36-year-old woman with familial adenomatous polyposis who underwent ileal J pouch-anal anastomosis. Fluoroscopic contrast examination shows contrast agent filling pouch (gray arrow) and vagina (arrowheads), expressing pouch-vaginal fistula (white arrow).

View larger version (127K): [in a new window]   Fig. 10A —Pouch-vaginal fistula in 35-year-old woman with ulcerative colitis who underwent ileal J pouch-anal anastomosis. CT examination with contrast enema shows fistulous track (arrow) linking anastomotic site and vagina.

View larger version (139K): [in a new window]   Fig. 10B —Pouch-vaginal fistula in 35-year-old woman with ulcerative colitis who underwent ileal J pouch-anal anastomosis. MRI examination (T1-weighted with fat suppression and IV gadolinium) shows fistulous track (arrow) linking anastomotic site and vagina.

View larger version (141K): [in a new window]   Fig. 11 —Pouch fistula in 52-year-old man with ulcerative colitis who underwent ileal J pouch-anal anastomosis. CT examination with contrast enema shows sinus track (black arrow) linking pouch (white arrow) and presacral collection (arrowheads).

View larger version (156K): [in a new window]   Fig. 12A —MRI examination in 52-year-old woman with ulcerative colitis who underwent ileal J pouch-anastomosis. Axial T1-weighted image with fat suppression and IV gadolinium shows enhanced sinus track posterior to ileal J pouch (arrow).

View larger version (154K): [in a new window]   Fig. 12B —MRI examination in 52-year-old woman with ulcerative colitis who underwent ileal J pouch-anastomosis. Sinus track extends to left ischioanal fossa (arrowheads).

View larger version (141K): [in a new window]   Fig. 12C —MRI examination in 52-year-old woman with ulcerative colitis who underwent ileal J pouch-anastomosis. Sinus track extends to left ischioanal fossa (arrowheads).

View larger version (154K): [in a new window]   Fig. 13A —MRI examination in 50-year-old woman with Crohn's disease who underwent total proctocolectomy and ileal J pouch-anal anastomosis. Axial T2-weighted image shows hyperintense presacral mass (arrow) diagnosed as pelvic abscess secondary to anastomotic leakage.

View larger version (143K): [in a new window]   Fig. 13B —MRI examination in 50-year-old woman with Crohn's disease who underwent total proctocolectomy and ileal J pouch-anal anastomosis. Axial T1-weighted image with fat suppression and IV gadolinium shows characteristic rim enhancement (arrow).

View larger version (119K): [in a new window]   Fig. 14 —Anastomotic stricture in 28-year-old woman with familial adenomatous polyposis who underwent ileal J pouch-anal anastomosis. Oblique radiograph of contrast enema examination shows ileal pouch-anal anastomotic stricture (white arrow) after J pouch opacification (black arrows). Note sinus track near pouch-anal anastomosis (arrowhead).

View larger version (129K): [in a new window]   Fig. 15A —Pelvic desmoid tumor in 29-year-old woman with familial adenomatous polyposis who underwent ileal J pouch-anal anastomosis. Axial T2-weighted image shows heterogeneous mass (white arrow) near upper pole of J pouch (black arrow).

View larger version (131K): [in a new window]   Fig. 15B —Pelvic desmoid tumor in 29-year-old woman with familial adenomatous polyposis who underwent ileal J pouch-anal anastomosis. Sagittal T2-weighted image shows heterogeneous mass (white arrow) near upper pole of J pouch (black arrow).

View larger version (142K): [in a new window]   Fig. 16 —Recurrent ileitis in 30-year-old man with Crohn's disease who underwent ileal J pouch-anal anastomosis. CT shows inflammatory thickening of ileal wall (arrow) with fat stranding.

View larger version (129K): [in a new window]   Fig. 17A —Specific pouchitis in 59-year-old woman with recurrent Crohn's disease who underwent ileal J pouch-anal anastomosis. CT examination shows pouch wall thickening (arrowheads). Note proliferation of fatty tissue (arrows) around ileal pouch.

View larger version (177K): [in a new window]   Fig. 17B —Specific pouchitis in 59-year-old woman with recurrent Crohn's disease who underwent ileal J pouch-anal anastomosis. Sagittal T2-weighted image shows fibrofatty proliferation (arrows) causing ileal pouch displacement.

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