Radiographic Evaluation of the Ileal-Pouch Anal Anastomosis

The ileal-pouch anal anastomosis is a means of preserving fecal continence in those patients undergoing total colectomy, primarily for treatment of ulcerative colitis and familial adenomatous polyposis. There are a variety of complications associated with the procedure, ranging from acute leaks to nonspecific pouchitis, and small bowel obstructions. Radiographic evaluation, primarily using conventional barium enemas and contrast-enhanced computed tomography, is crucial in guiding clinical management of these patients. Recent technical advancements in magnetic resonance imaging render this modality a potentially viable imaging alternative, while avoiding ionizing radiation. This article reviews the normal postoperative appearance and depicts a variety of radiographic complications associated with pouch creation.