Ileal Pouch Reconstruction Risks and Complications

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 vast nature of total abdominal colectomy and ileal pouch reconstruction predisposes you to complications that, if treated early, can be minimized. About one in five patients experiences problems, the most common of which include bowel obstruction (frequently treated non-surgically), infection, anastomotic or pouch healing problems, and steroid withdrawal symptoms.
Blood loss or anemia, poor nutrition, your age and previous surgery can increase your chance of post-operative problems.
Bleeding, infection, incontinence or inadequate reach between the pouch and the anal canal may cause the ileal reservoir to fail. Such occurrences are infrequent. Ulcerative colitis patients are at greatest risk for failure, as the steroid or immunosuppressive medications used to treat the condition can adversely affect healing.
If the reservoir fails, a permanent ileostomy may be required. Everything will be done to recognize the early signs of such complications and treat them appropriately.
A non-specific inflammation of the ileal reservoir usually occurs during the first two years after pouch reconstruction and can be a long-term problem for some patients. Most have symptoms, including steadily increasing stool frequency that may be accompanied by incontinence, bleeding, fever and/or a feeling of urgency. Most cases can be treated with a short course of antibiotics.
Patients who undergo total abdominal colectomy and ileal pouch reconstruction for familial polyposis rarely, if ever, develop pouchitis. Of those who have ulcerative colitis, approximately 20 to 30 percent experience at least one episode. Among patients experiencing pouchitis symptoms, five to seven percent may have chronic symptoms that require repeated antibiotic treatment.
Even in severe cases, pouchitis rarely requires pouch removal. If you have any or all of these symptoms, notify your surgeon, primary physician or gastroenterologist immediately.
Physical Activity after Surgery
Certain activities such as driving or lifting may be restricted initially after surgery. With time, we encourage normal physical activity, including participation in sports.