Ask Dr. Schiller: Can A Failed J-Pouch Put My Health At Risk?

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5 Possible Complications From A Failed J-Pouch

Made from the end of the small intestine and attached to the anal cavity to create a passageway for stool, a J-pouch is a type of reservoir surgeons create when they remove the colon and rectum of patients with the digestive disorders, ulcerative colitis or familial polyposis. J-pouches work well in most cases but can sometimes fail.

Since its introduction in the 1970s, surgeons regard the J-pouch as the go-to surgical intervention for chronic ulcerative colitis and familial polyposis. While it is the gold standard treatment, post-operative complications from a failed J-pouch can put your health and well-being at risk in at least five ways.

1. Pelvic Sepsis

Pelvic sepsis is the main cause of J-pouch failure and the most serious complication after surgery. Sepsis is a serious condition characterized by a whole-body inflammatory response to infection. Pelvic sepsis can develop three to six days after surgery. Patients who have not had a previous ileostomy, the surgical procedure that brings part of the intestine to the outside of the body, are at higher risk for this condition.

The infection leading to pelvic sepsis is often the result of leaks developing along suture lines or bacterial contamination during surgery. Signs and symptoms of pelvic sepsis include fever, abdominal pain, pus-like discharge and high white blood cell counts.

2. Leaks

Leaks can develop in three areas: in the pouch itself, at its tip or in the area where the pouch connects to the anus. Leaks are more common in elderly patients, those who take corticosteroids and in men. Leaks will sometimes heal on their own but some patients will need additional surgeries or treatments to correct the leak.

3. Small Bowel Obstruction

The risk for small bowel obstruction with a J-pouch is high, according to a study published in the Annals of Surgery, affecting as many as 44 percent of patients. The researchers in the study found the risk of small bowel obstruction is 9 percent at 30 days post surgery, 18 percent one year later, 27 percent at five years and 31 percent at 10 years. Most do not require surgical intervention to correct small bowel obstruction.

4. Pouchitis

Pouchitis is inflammation of the ileal reservoir. Affecting about half of all people who receive a J-pouch, pouchitis is the most common complication of a J-pouch. Symptoms of pouchitis include increased stool frequency, diarrhea, urgency, fecal incontinence, abdominal pain, and fever.

5. Fistula

A fistula is an abnormal connection between tissues or organs. Several months after receiving a J-pouch, patients may develop a vaginal, perineal, cutaneous or presacral fistula. Doctors can treat fistulas with antibiotics in some cases but must resort to surgery in other cases.

A failed J-pouch can force a patient to endure multiple invasive procedures and surgeries in addition to experiencing discomfort and inconvenience. Patients concerned about the health risks associated with failed J-pouches should speak with their doctors to learn how to avoid complications.