RadioGraphics 2010; 30:221-233
Jennifer C. Broder, MD .Jaroslaw N. Tkacz, MD ,Stephan W.Anderson, MD Jorge A. Soto, MD . Avneesh Gupta, MD
Ileal pouch-anal anastomosis (IPAA) surgery preserves fecal continence for improved quality of life in patients who require proctocolectomy for treatment of severe bowel diseases such as inflammatory disease and familial adenomatous polyposis. In IPAA surgery, an ileal reservoir, or pouch, is created and anastomosed to the anal canal. Awareness of the surgical technique and the postoperative anatomy of the IPAA is im¬portant to identify complications at computed tomography (CT), mag¬netic resonance (MR) imaging, and fluoroscopy. Complications include anastomotic leak, abscess, pouchitis, venous thrombus, pouch fistula, and stricture. Leaks from the blind end of the pouch and the pouch-anal anastomosis often result in pelvic abscesses, which may require ultrasonography- or CT-guided drainage; judicious catheter manage¬ment can help improve clinical outcomes and avoid excessive imaging. Pouchitis may be identified by the presence of a thickened enhancing pouch wall and associated inflammatory changes and lymphadenopathy. The venous system must be scrutinized for thrombi secondary to surgi¬cal manipulation and sepsis. Fistulas are likely because of the presence of chronic inflammation or infection and may be seen at MR imaging, CT, or fluoroscopy. Strictures appear as areas of focal luminal narrow¬ing with proximal dilatation, which can lead to obstruction. To avoid repeated exposure to radiation, MR imaging may be performed in pa¬tients who must undergo frequent imaging.