Radiology of ileal pouch-anal anastomosis: normal findings, examination pitfalls, and complications

Ileal pouch-anal anastomosis (IPAA) is a procedure in which an ileal reservoir is constructed after total colectomy and anastomosed to the anus. IPAA is a well-established option for patients who require surgery for chronic ulcerative colitis or familial adenomatous polyposis. Although excellent functional results can be achieved with IPAA, the procedure is associated with an appreciable number of complications, including small bowel obstruction, pouch fistula, anastomotic separation, anastomotic leakage, pelvic infection and abscess, stricture, and pouchitis. However, most of these complications do not require surgical intervention and can be managed with aggressive medical treatment and delay of ileostomy closure. Radiography of the IPAA pouch is routinely performed before closure of the diverting ileostomy to evaluate the integrity of the pouch and anastomosis. Such radiography can demonstrate many of the complications of IPAA, thus allowing identification of patients who may require intervention or delay before closure of the ileostomy.