Ileal Pouch Anatomy and Terminology

Ileal pouch reconstruction at UW Health in Madison, Wisconsin, has allowed patients with conditions such as ulcerative colitis, familial polyposis and certain types of colon cancer to avoid living with a permanent ileostomy and external appliance after colectomy. 
The following are brief descriptions of some terms used in describing reconstructive colon surgery:
  • Anastomosis: The surgical connections between the loops of small intestine that make up the pouch. This also refers to the connections between the ileum and anal canal. 
  • Colon: The portion of the large intestine that extends from the cecum to the rectum (bottom section). The colon's primary function is to absorb water and serve as a reservoir for stool. 
  • Ileal pouch reconstruction: This is the technical term for the procedure that combines complete removal of the colon and creation of a new rectum using the ileum. This procedure may also be referred to as ileal reservoir reconstruction, ileal pouch-anal anastomosis, restorative proctocolectomy, or W-, S-, or J-pouch reconstruction. 
  • Loop ileostomy: A loop of bowel brought to the skin's surface to divert bowel contents away from the newly created ileal pouch. The ileostomy empties into an external appliance that must be changed regularly. Ileal pouch reconstruction patients may live with a temporary ileostomy for about two months or until the internal pouch has adequately healed. Ileostomy takedown refers to the removal of the temporary ileostomy. 
  • Neorectum: A new rectum created from the end of the small bowel. 
  • Small bowel: The small bowel consists of two parts: the upper portion, called the jejunum, and the lower portion, called the ileum. We use approximately 12 to 15 inches of the ileum for pouch reconstruction. 
  • Sub-total colectomy: Removal of the colon but not the rectum. 
  • Total abdominal colectomy or proctocolectomy: Complete removal of the colon and rectum