Cuff abscesses and ileoanal anastomotic separations in pelvic pouch surgery. An analysis of possible etiologic factors.

In many reports, mucosal proctectomy and ileoanal anastomosis has been reported as a procedure afflicted with a considerably high frequency of cuff abscesses and ileoanal anastomotic separations. In order to find the predisposing factors the charts of 20 early pouch patients were reviewed; ten of these patients had these complications and ten constituted a control group. There were two striking findings about the complication group: a tendency toward more severe rectal gross inflammation and troublesome mucosectomy, and consistently very long, greater than or equal to 7 cm, acute angulated, efferent conduits, and severe evacuation difficulties. Reconstruction of the pouch, with shortening of the efferent limb, was necessary for definite cure in all but one patient. The cuff abscess seemed to be either a descending infection, or an infection ascending from a disrupted anastomosis, a rupture provoked by a long, kinked efferent conduit. After introduction of the S-pouch with short spout and the J-pouch, this feared complication did not appear.