Small bowel (small intestine) - Ileal pouch / pouchitis

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Small bowel (small intestine)

Inflammatory disorders

Ileal pouch / pouchitis

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 15 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● 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

Pouchitis
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● Incidence 8% to 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

Treatment
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● Antibiotics, pouch excision

Micro description
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● 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)

Micro images
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CMV pouchitis: biopsy of post-colectomy pouch in 38 year old man with ulcerative colitis (courtesy of Dr. Hanni Gulwani)

CD10 staining

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

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