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Pouch wall thickness and floppy pouch complex
Khan Freeha1, Sze Grace1, Lan Nan2
1Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Insights
Floppy pouch complex (FPC) is associated with thinner pouch walls, while inflammatory pouch conditions show thicker walls. This finding aids in diagnosing FPC and understanding its causes.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Medical Imaging
Background:
- Floppy pouch complex (FPC) encompasses various ileal pouch complications, including prolapse and afferent limb syndrome.
- Previous research identified risk factors for FPC in inflammatory bowel disease (IBD) patients, such as lower body weight and female gender.
Purpose of the Study:
- To evaluate the correlation between pouch wall thickness and FPC.
- To investigate the association between inflamed and non-inflamed pouch wall thickness in patients with ileal pouches.
Main Methods:
- A case-control study was conducted using data from a prospectively maintained Pouchitis Registry (2011-2017).
- Pouch wall thickness was measured from cross-sectional abdominal and pelvic imaging of fully distended pouches.
- Patients with stoma or non-distended pouches were excluded from the analysis.
Main Results:
- Out of 451 patients, 140 had fully distended pouches, with 36 (25.7%) diagnosed with FPC.
- FPC patients exhibited a median pouch wall thickness of 1.5 mm (range: 1.0-2.0 mm) across different subtypes.
- Inflammatory conditions like pouchitis and cuffitis were associated with significantly thicker pouch walls (2.3 mm and 2.0 mm, respectively) compared to normal pouches (1.5 mm).
Conclusions:
- Patients diagnosed with FPC generally present with thinner pouch walls.
- Conversely, inflammatory conditions of the ileal pouch are characterized by thicker pouch walls.
- These distinctions in pouch wall thickness have significant implications for the diagnosis and etiological investigation of these pouch-related disorders.
Background:
Floppy pouch complex (FPC) consists of disease phenotypes in patients with ileal pouches, including pouch prolapse, afferent limb syndrome, enterocele, redundant loop, and pouch folding. Our recent study demonstrated that lower body weight, lower peripouch fat, family history of inflammatory bowel disease (IBD), female gender, and dyschezia are risk factors for FPC patients with IBD. The aims of this study were to assess the relationship between pouch wall thickness and FPC, and to investigate the association between inflamed and non-inflamed pouch wall thickness.
Methods:
This case-control study included all eligible patients with FPC from our prospectively maintained, IRB-approved Pouchitis Registry from 2011 to 2017. We measured pouch wall thickness of fully distended pouches on cross-sectional abdominal and pelvic imaging. Patients with stoma and non-distended pouches were completely excluded. Risk factors for FPC were analyzed.
Results:
A total of 140 out of 451 patients from our were found to have fully distended pouches on imaging. Of the 140 patients, 36 (25.7%) were diagnosed as having FPC. We analyzed pouch wall thickness for each subcategory of FPC as well as non-FPC conditions. The thickness of pouch wall was follows: pouch prolapse (N = 19): 1.5 mm (1.5-2.0), afferent limb syndrome (N = 12): 1.5 mm (1.1-2.0), folded pouch (N = 4): 1.5 mm (1.1-1.9), and redundant pouch (N = 2): 1.3 mm (1.0-1.3). The control group (N = 104) consisting of normal pouch, pouchitis, cuffitis, Crohn's disease of the pouch, and pouch sinus with median pouch wall thickness of 1.5 mm, 2.3 mm, 2.0 mm, 2.0 mm, and 1.5 mm, respectively. There were significant differences in pouch wall thickness between normal or non-inflamed pouch versus pouchitis versus cuffitis versus Crohn's disease of the pouch with p values of 0.01, 0.04, 0.05, and 0.049, respectively.
Conclusion:
Patients with FPC were shown to have thin pouch wall, which those with inflammatory conditions of the pouch tended to have thick pouch wall. These findings will have implications in both diagnosis and investigation of etiopathogenesis of these disorders.
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