Small intestine & ampulla

Inflammatory disorders

Ileal pouch / pouchitis

Topic Completed: 1 August 2012

Minor changes: 14 September 2020

Copyright: 2003-2021,, Inc.

PubMed Search: Ileal pouch pouchitis small bowel[TIAB]

Hanni Gulwani, M.B.B.S.
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Cite this page: Gulwani H. Ileal pouch / pouchitis. website. Accessed December 8th, 2021.
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

Contributed by Hanni Gulwani, M.D.

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

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