Most common cause of morbidity in post operative cases of UC in ilioanal anastomosis ?
|D||Sepsis small intestinal obstruction|
(Ref: Mairgot’s abdominal operation 17th edition, Pg- 768)
a. IPAA is most commonly for the treatment of ulcerative colitis.
b. The most common and significant care complication of IPAA is pouchitis occurring is more than 50% of the pelvic.
c. Patient with pouchitis presents with increased stool frequency, watery diarrhoea, fecal urgency, incontinence, rectal bleeding, abdominal ramping, fever and malaise.
d. Diagnosis is made by flexible ileal pouchoscopy. The mucosal surface of normal pouch glistens and has velvety appearance due to normal iliac mucosa.
e. An inflamed pouch appears erythematous exematous, hyperemic and granular.
f. Endoscopic appearance does not however always correlate with the clinical presentation.
g. Overall incidence of pouchitis is 22%.
h. Broad spectrum antibiotics continue to remain mainstay of treatment, especially for patients with acute or episode flare up.
i. Low dose ciprofloxacin (250 mg) with metronidazole (200 mg daily) for a period of 90 days is preferred treatment.
j. Incidence of complication.
i. Pouchitis – 22% ii. Small int. Obstruction – 17%
iii. Pelvic abscess – 77% iv. Sinus tract – 1%
v. Pouch failure 0. 2%