Small bowel (small intestine)
Inflammatory disorders
Ileal pouch / pouchitis

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 13 February 2018, last major update August 2012

Copyright: (c) 2003-2018,, Inc.

PubMed Search: Ileal pouch pouchitis small bowel[TIAB]

Cite this page: Gulwani, H. Ileal pouch / pouchitis. website. Accessed March 23rd, 2018.
Definition / general
  • Pouch is formed from connecting loops of terminal ileum for patients requiring total colectomy; used to create continence in an ileostomy or to preserve anal sphincter function
  • Pouches are contraindicated in Crohn's disease because they are associated with fistulas and abscess
  • Complications: fistula, obstruction, incontinence, leaks, pouchitis
  • Incidence 8 - 46%
  • Some cases are due to initially undiagnosed Crohn's disease
  • Nausea, vomiting, malaise, fever, cramping
  • Increased ileal stool that is bloody, watery, foul smelling
  • Often with altered bacteria
  • Antibiotics, pouch excision
Microscopic (histologic) description
  • Decreased epithelial cell mucin, few / no lymphoid follicles
  • Ulcers with granulation tissue, cryptitis, crypt abscesses and patchy neutrophils
  • Rarely dysplasia
  • CD10 staining confirms biopsy site - terminal ileum (CD10+) versus colon (CD10-), although negative staining also occurs in active enteritis (Mod Pathol 2011;24:1627)
Microscopic (histologic) images

Images hosted on other servers:

Images contributed by Dr. Hanni Gulwani:

CMV pouchitis: biopsy of postcolectomy pouch in 38 year old man with ulcerative colitis