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Session: ePoster Monitor 5-IBD 2

eP617 - Management of Pouch Prolapse: A Single Center Experience

Monday, June 3, 2024
10:36 AM – 10:41 AM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • BM

    Brenda Murphy, MB BCh BAO MCh MD

    Fellow
    Mayo Clinic
    Mayo Clinic
    Rochester, MN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • RB

    Richa Bisht, n/a

    PG1
    Mayo Clinic
    Rochester, Minnesota, United States

    Disclosure information not submitted.

  • Behm T. Kevin, M.D., FACS

    Assistant Professor of Surgery Division of Colon and Rectal Surgery
    Mayo Clinic
    Rochester, Minnesota, United States

    Disclosure information not submitted.

  • Kellie L. Mathis, MD, FACS, FASCRS (she/her/hers)

    Professor of Surgery
    Mayo Clinic
    Mayo Clinic
    Oronoco, Minnesota, United States

    Disclosure information not submitted.

  • Georgios Kyriakopoulos, MD, MSc, PhD

    Colorectal Surgery Fellow
    Mayo Clinic, Rochester, MN
    Rochester, MN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • SS

    Sherief Shawki, MD, FACS, FASCRS

    Consultant, colon & Rectal surgery
    Mayo Clinic Rochester
    Rochester, Minnesota, United States

    Disclosure information not submitted.

  • Robert Roland Cima, MD

    Professor of Surgery
    Mayo Clinic
    Rochester, Minnesota, United States

    Disclosure information not submitted.

  • David w. larson, MD MBA

    consultant and professor of surgery
    mayo clinic
    rochester, Minnesota, United States

    Disclosure information not submitted.

  • Eric Joseph Dozois, Professor of Surgery

    Chair, Colon and Rectal Surgery
    Mayo Clinic
    Rochester, Minnesota, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • WP

    William Perry, MBChB MPH FRACS FACS FASCRS (he/him/his)

    Assistant Professor
    Mayo Clinic
    Mayo Clinic
    Rochester, MN, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no financial relationships with ineligible companies.

Purpose/Background: Ileal pouch prolapse is a rare phenomenon with a paucity of cases seen even in high volume institutions. There are no known predisposing factors or established management guidelines. Certain factors are postulated to increase risk including female gender and absence of peri-pouch fat. We present a single center experience of pouch prolapse management and outcomes.Methods/Interventions: Patients were retrospectively identified from electronic health records. Baseline demographics, procedure details, time to diagnosis of pouch prolapse, subsequent intervention and outcomes were extracted.Results/Outcomes: Twenty-six patients were found to have ileal pouch prolapse on imaging, endoscopy or examination. Twenty (76.9%) were female and 6 (23.1%) were male. The median age was 39. The indications for pouch were ulcerative colitis in all cases within this cohort. Twenty-five had a “J” pouch, one had an “S” pouch. The median time from pouch formation to prolapse was 39 months. A total of 23 patients retained their pouch, with only four undergoing excision with conversion to end ileostomy. A total of eight patients underwent pouch pexy alone or after pelvic floor physiotherapy with two documented recurrences requiring a second pouch pexy within 24 months. One patient undergoing pouch pexy had an emergency return to the operating room for pouch obstruction resulting in release of pouch pexy and ultimately, pouch revision. The average length of stay following pouch pexy was 5.5 days. Four patients were managed with pelvic floor physiotherapy including biofeedback alone with resolution of prolapse symptoms. Four patients were prescribed pouch irrigation or drainage, one of whom had failed physiotherapy and two previous pouch pexy surgeries. Three patients deferred further treatment or workup and were managed conservatively through diet and lifestyle.Conclusion/

Discussion: Pouch prolapse is a rare condition with multiple treatment options available depending on patient and surgical factors. Pouch preservation is possible utilizing a pexy or more conservative strategies. Further research is needed to identify precipitants and establish evidence-based management guidelines.