The Pediatric Pouch in Inflammatory Bowel Disease

A Primer for the Gastroenterologist

Ghassan T Wahbeh; David L Suskind; Scott D Lee; John T Waldhausen; Karen F Murray

Disclosures

Expert Rev Gastroenterol Hepatol. 2013;7(3):215-223. 

In This Article

Permanent Ileostomy

The current surgical techniques, including stoma protective devices and dedicated 'stoma teams' at larger centers, make a permanent ileostomy a feasible and acceptable option for some children. The small intestine generally shows enough adaptation to compensate for fluid and mineral losses after a colectomy. Nevertheless, maintaining adequate hydration and mineral intake remains essential, especially for active children. The stoma output (volume, consistency) tends to be sensitive to components of the oral intake. Complications include skin irritation, obstruction, volvulus, dehiscence and associated nephrolithiasis.[9] A permanent ileostomy may offer some advantages over restoring continuity; possible fertility preservation, avoiding pouchitis (see below) and, surprisingly, few restrictions on activity. One of our patients, who is quite involved in outdoors activities, found the permanent ileostomy option more convenient than a pouch after weighing the expected stool frequency and the risk of pouchitis (see below) if he happened to be on a long hike. How does ileostomy compare with IPAA when it comes to quality of life? Although body image perception is thought to be poorer in adults with ileostomy, the quality of life is quite similar to IPAA patients.[10]

The overwhelming majority of children and adults with UC opt to be in bowel continuity. Perhaps the main reasons for this choice are restoring a 'healthy' body image without the stoma and the desire to defecate normally similar to peers. Additionally, there is the burden of stoma care to children and their caregivers. Patients may generally underestimate the potential complications of surgery to restore bowel continuity. Two surgical options have been most commonly used: IAA or IPAA, commonly termed J-pouch, named for its shape (Figure 1). Other technically different pouches have been used, including the S and W pouches.

Figure 1.

The J-pouch. Reproduced with permission from [68].

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