What is a J-Pouch?

What_Is_A_JPOUCH

What is a J-Pouch?

JPouch Info

(click to see larger version)

Many patients with ulcerative colitis (UC) undergo a procedure called the ileal-pouch anal anastomosis (IPAA). IPAA is also known as J-Pouch surgery. Sources vary, but in my research, I’ve read that anywhere from 15-50% of ulcerative colitis patients will eventually have surgery.

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

1, 2 or 3 Stages

J-Pouch construction remains the same whether the procedure is done in one, two or three stages. The number of stages depends on several factors. The health of the patient, the skill set and experience of the surgeon, and the severity of inflammation are just some of the determining factors.

J-Pouch history begins in 1933, which I explain in my previous post (read more here). Many advancements have been made, despite the J-Pouch’s brought beginnings. With these advancements, patients tend to prefer it to an ileostomy.

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

Inside the J-Pouch

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.

The J-pouch is created out of the small intestine and curved up into the shape of a “J,” which is how the pouch gets it’s name. It is then attached at the anus with the anal sphincters in tact. This allows the patients to hold stool for extended periods of time.

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. It holds approximately two cups of stool. Despite the small size, most patients do not experience the same urgency as with a diseased colon.

Possible Complications

In 2013, surgeons from Paris and India found the following to be the most common complications:

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

Despite complications, actual pouch failure only occurs in about 6% of all patients. Many of the complications are easily treatable. Approximately 94% of patients report a better quality of life. I am thankful to be included in that percentage.

In general, surgeons do not perform the J-Pouch procedure for patients of Crohn’s Disease. This is due to the fact that Crohn’s 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?

Jpouch Anatomy

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)

Take a look at fig. 1. As you can see, this is the anatomy of a J-Pouch. The efferent limb is on the left side of the pouch (fig 1.3), and you can see that this part was, at one point, connected to the colon. The afferent limb, on the right side (fig 1.1), juts upward and eventually 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 the rectal cuff where the pouch is attached (fig 1.7) right above the anal transition zone (ATZ fig 1.8). Then of course, you can see at fig 1.6 and fig 1.5, the anus and the anal sphincters, respectively.

Inside of J-Pouch

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

So there you have it! If you are thinking about getting a J-Pouch, or having trouble explaining what exactly it is, feel free to share this with your family and friends. I hope you found this informative. I know I truly enjoyed writing this blog post. If any of you have any questions about my life with a J-Pouch, you can read more about it here, or even email me. I love answering questions and connecting with people… especially if I think I am able to help. God bless and take care!

 

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

J-PouchHistory

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