J-Pouch: Important Things You Need to Know [infographics]

You may have heard the term J-Pouch. But what is it exactly? Many patients with ulcerative colitis (UC) need surgery. In this case we’re talking about ileal-pouch anal anastomosis (IPAA). IPAA is also known as J-Pouch surgery. Sources vary, but anywhere between 15-50% of patients will need surgery.

What is a J-Pouch?

(click to see larger version)

The IPAA procedure involves removing the entire colon and rectum. A “pouch”, or reservoir is then created out of the small intestine. This allows patients to retain continence and hold stool (poop).

1, 2 or 3 Stages

The first stage of j-pouch construction involves a total colectomy. Your surgeon then constructs a j-pouch (performed in one, two or three stages). The number of stages depends on several factors. For example, the health of the patient is a big factor. The skill set and experience of the surgeon is another. Inflammation also comes into play.

This Procedure is Brought to You By the Letter “J”

fig 2 – Healthy J-Pouch 1. owl’s eye formation at the tip of J-Pouch, 2. Dr. Peter Higgins explained to me that there is a linear ulcer located at the “fold” of the J-Pouch. It is thought that this is due to the decrease of blood flow to the area. This ulcer is completely unrelated to pouchitis.

Your surgeon takes your small intestine and forms it into the shape of a “J.” That is why it’s called a j-pouch. The pouch is then attached at the anus with the anal sphincters in tact. Because of this, patients are able hold stool for extended periods of time. Compared to the ostomy, in which stool runs out into an external bag. For this reason, many prefer this option.

Frequency, Size and Volume

Most patients report frequency anywhere between 3-5 bowel movements a day. Many patients report that they are able to “hold it” through the night. The average size of a J-Pouch is about 4 inches in length and about 2 inches in diameter. And it holds approximately 2 cups of stool. Despite the small size, most patients do not experience the same urgency as with a diseased colon. Nevertheless, when people hear surgery, they freak out.

Possible Complications

People are scared of surgery. After all, surgery is a big deal. Because surgery can come with complications. Surgeons have found the following to be the most common complications:

• hemorrhaging
• small bowel obstructions
• pelvic sepsis
• fistulas
• pouchitis

J-Pouch Failure?

Despite complications, actual pouch failure only occurs in about 6% of all patients. Many of the complications are treatable. Approximately 94% of patients report a better quality of life. I am happy to inform you that I am in that statistic.

The Crohn’s Factor

While some patients with Crohn’s disease have a j-pouch surgeons do not recommend it. This is due to the fact that inflammation can occur anywhere in the digestive tract. Because of this, an ostomy is a more successful treatment.

So what does a J-Pouch look like?

fig 1 1. afferent limb, 2. tip of J-Pouch, 3. efferent limb, 4. apex of J-Pouch, 5. anal sphincters, 6. anus, 7. rectal cuff, 8. anal transition zone (ATZ)

Fig. 1 shows the anatomy of a J-Pouch. The efferent limb is on the left side of the pouch (fig 1.3). This is where the small intestine connected to the cecum part of the colon. The afferent limb, on the right side (fig 1.1), juts upward and connects to the stomach. The tip of the pouch is at the top (fig 1.2), and the apex of the pouch is at the bottom, connected to the anus (fig 1.4). You can also see where the rectal cuff meets the pouch (fig 1.7) right above the anal transition zone (ATZ fig 1.8). See the illustration of the anus and anal sphincters in fig 1.6 and fig 1.5.

Conclusion

fig 3. 1. Serosa, the outer wall of the J-Pouch; 2. Inside the J-Pouch, made up of Epithelial Cells

In conclusion, if you are thinking about getting a J-Pouch, there’s a basic explanation. Also, feel free to share this with your family, friends (or uninformed medical team). I hope you found this helpful. Because I enjoyed writing and illustrating this post. In fact, this is my favorite one! As always, if you have any questions about my life with a J-Pouch, browse the site. And you can email me, too! In fact I love connecting with people… especially if I am able to help. God bless and take care!

DISCLAIMER: Remember, I am not a doctor or medical professional. Information seen here is a result of my research of J-Pouches. Therefore, please see my disclaimer for more details.

SOURCES:

Pouchitis: What Every Gastroenterologist Needs to Know
Bo Shen – Clinical Gastroenterology and Hepatology – 2013

Surgical treatment of ulcerative colitis: Ileorectal vs ileal pouch-anal anastomosis
Daniele Scoglio – World Journal of Gastroenterology WJG – 2014

Ileal pouch–anal anastomosis
B. B.Mcguire – A. E.Brannigan – P. R.O’connell – British Journal of Surgery Br J Surg – 2007

Complications of Ileoanal Pouches
Clinics in Colon and Rectal Surgery – 2004

Ileal-Pouch-Anal Anastomosis After Restorative Proctocolectomy in Patients With Ulcerative Colitis or Familial Adenomatous Polyposis – 11 Years of Experience
Wiktor Bednarz – Robert Olewiński – Jerzy Woldan – Polish Journal of Surgery – 2007

Radiology of the Ileal J-Pouch — Anal Anastomosis (IPAA)
G. Hagen – Finn Kolmannskog – S. Aasen – A. Bakka – T. Løtveit – Ø. Mathisen – Acta Radiologica Acta Radiol – 1993