The pediatric pouch in inflammatory bowel disease: a primer for the gastroenterologist

Ghassan T Wahbeh Inflammatory Bowel Disease Program, Seattle Children’s Hospital, University of Washington, W7830, Gastroenterology, 4800 Sand Point Way NE, Seattle, WA 98105, USA. [email protected]; Inflammatory Bowel Disease Program, Seattle Children’s Hospital, University of Washington, W7830, Gastroenterology, 4800 Sand Point Way NE, Seattle, WA 98105, USA. [email protected]

David L Suskind Quality Improvement, Division of Gastroenterology, Seattle Children’s Hospital, University of Washington, W7830, Gastroenterology, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Quality Improvement, Division of Gastroenterology, Seattle Children’s Hospital, University of Washington, W7830, Gastroenterology, 4800 Sand Point Way NE, Seattle, WA 98105, USA

Scott D Lee Clinical Inflammatory Bowel Disease Program, University of Washington, Box Number: 356424, 1959 NE Pacific Street, Seattle, WA 98195, USA; Clinical Inflammatory Bowel Disease Program, University of Washington, Box Number: 356424, 1959 NE Pacific Street, Seattle, WA 98195, USA

John T Waldhausen General and Thoracic Surgery, Seattle Children’s Hospital, University of Washington, W7753 Department of Surgery, 4800 Sand Point Way NE, Seattle, WA 98105, USA; General and Thoracic Surgery, Seattle Children’s Hospital, University of Washington, W7753 Department of Surgery, 4800 Sand Point Way NE, Seattle, WA 98105, USA

Karen F Murray Gastroenterology and Hepatology, Seattle Children’s Hospital, University of Washington, W7830, Gastroenterology, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Gastroenterology and Hepatology, Seattle Children’s Hospital, University of Washington, W7830, Gastroenterology, 4800 Sand Point Way NE, Seattle, WA 98105, USA

Abstract

Pediatric severe ulcerative colitis that is resistant to current medical treatment can successfully be managed surgically with a colectomy, ileal pouch creation and pouch–anal anastomosis. Key issues that should be considered and discussed before the pouch option can be offered include alternative surgical procedures, pouch function expectations, risk of surgical leak, pelvic sepsis, anastomotic strictures, acute and chronic pouch inflammation, Crohn’s disease of the pouch and risk of reduced fertility for females. A long-term risk is malignancy of the residual colonic tissue. The decision to proceed with a pouch or not poses a substantial emotional burden to the child and family. Despite the risk of surgical complications and pouch inflammatory and functional challenges, the overwhelming majority of children and their families are satisfied with their pouch surgery outcomes. Further study is needed to assess preoperative risk predictors, prevention and treatment of complications.

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Acknowledgements

The authors wish to acknowledge Leslie Lewinter for her help in preparing this manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

Adapted from Citation[66,67].

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The pediatric pouch in inflammatory bowel disease: a primer for the gastroenterologist

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The pediatric pouch in inflammatory bowel disease: a primer for the gastroenterologist

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