Management of pouch-specific complications

There are numerous specific complications associated with the ileal pouch anal anastomosis (IPAA). These include fistulae, strip pouchitis, anastomotic sinus or stricture, and other, more unusual, complications. Such difficulties are largely caused by either a technical problem with the surgical procedure itself or are manifestations of recurrent inflammatory bowel disease, including Crohn's disease or retained rectal mucosa. Their management is relatively straightforward, and long-term success rates are very good if the underlying cause does not relate to Crohn's disease. In the case of Crohn's disease, systemic management with metronidazole and immunosuppressive medications, including 6-MP and infliximab, in association with appropriate local care, can effectively save the majority of pouches.