Judging the J pouch: a pictorial review

Area of Science:

• Gastrointestinal Surgery
• Radiology
• Medical Imaging

Background:

• Restorative total proctocolectomy with ileal pouch-anal anastomosis is a key surgical option for ulcerative colitis and familial adenomatous polyposis.
• While generally successful, patients can face significant long-term pouch-related complications.
• Radiologists require specialized knowledge of surgical techniques and anatomy for accurate diagnosis.

Purpose of the Study:

• To provide an imaging review of ileal pouches and their complications.
• To enhance radiologist understanding of pouch anatomy and associated morbidities.
• To aid clinical and surgical decision-making through illustrative imaging examples.

Main Methods:

• Anatomically-based review of ileal pouch imaging.
• Discussion of imaging modalities for assessing pouch complications.
• Inclusion of fluoroscopic and cross-sectional imaging examples.

Main Results:

• Detailed imaging appearance of normal pouch anatomy.
• Identification of common early and late pouch-related complications.
• Comparison of imaging modality strengths and weaknesses.

Conclusions:

• Radiologist familiarity with pouch surgery and imaging is crucial for managing complications.
• This review serves as a guide for interpreting pouch imaging studies.
• Accurate imaging assessment supports optimal patient management and outcomes.