The fourth bronchial pouch fistulae is the lesion of the fourth bronchial-pharyngeal duct in development of the embryo. 20 cases of this disease were diagnosed, operated and followed-up in the institute of ENT, from 1995 to 1997. 11 females and 9 males were affected; It manifested itself by recurrent episodes neck abscess, especially on the left side (95%). 13 fistulous tracts were found on operation with 86% of retrocartilaginous course.
Bronchial Fistula ; Pouchitis

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the surgical treatment of choice for patients with medically refractory ulcerative colitis (UC) or UC with dysplasia and for the majority of patients with familial adenomatous polyposis. However, UC patients with IPAA are susceptible to a number of inflammatory and non-inflammatory sequelae, such as pouchitis, Crohn disease(CD) of the pouch, cuffitis, and irritable pouch syndrome, in addition to common surgery-associated complications, which adversely affect the surgical outcome and compromise patient's health-related quality of life. Pouchitis is the most frequent long-term complication of IPAA in patients with UC, with a cumulative prevalence of up to 50%. Pouchitis may be classified based on the etiopathogenesis into "idiopathic" and "secondary" types and the management is often different. Pouchoscopy is the most important tool for the diagnosis and differential diagnosis in patients with pouch dysfunction. Antibiotic therapy is the main stay of treatment for active pouchitis. Some patients may develop dependency on antibiotics, requiring long-term maintenance therapy. While management of antibiotic-dependent or antibiotic-refractory pouchitis has been challenging, secondary etiology for pouchitis should be evaluated and modified, if possible.
Humans ; Pouchitis ; diagnosis ; etiology ; therapy

There is scientific evidence that administration of probiotics is effective in the treatment of acute infectious diarrhea in children and the prevention of antibiotic associated diarrhea and nosocomial/ community acquired diarrhea. Probiotics prevent relapse of recurrent pouchitis and decrease the initial onset of pouchitis in ulcerative colitis. Probiotic organisms suppress growth of pathogens as well as their epithelial attachment and/or invasion either directly by secreting antimicrobial substances or by stimulating host expression of protective molecules. Additionally, probiotics enhance mucosal barrier function and can stimulate host production of immunosuppressive molecules that downregulate inflammatory responses or allergic immune response. Mechanisms of action explain therapeutic effects and randomized controlled trials are warranted before recommendations for therapeutic or preventive use can be given.
Child ; Colitis, Ulcerative ; Diarrhea ; Epithelial Attachment ; Humans ; Pouchitis ; Probiotics* ; Recurrence

PURPOSE: To evaluate the effectiveness of a P-pouch configuration with a reservoir and recycled segment in restorative proctocolectomy. METHODS: There were 11 patients who underwent the P-pouch procedure. They were compared with healthy eight-control subjects. The P-pouch configuration was constructed using one firing of a 10 cm GIA stapler to form a 12-cm reservoir. Following that, the distal ileum (15+/-0.5 cm) was anastomosed to the proximal portion of the pouch. Pouch function was studied 23.3+/-4.4 months after ileostomy closure. We measured the frequency and amount of stool. The postprandial plasma peptide YY (PYY) response and the scintigraphic studies using 99m-Tc sulfur colloid were used to study transit. RESULTS: In the patient group, daily stool frequency and volume were 5.2+/-0.3 and 423.5+/-23.7 g, respectively. Stool seepage and pouchitis occurred in 45.5 % and 9.1%. In contrast to other pouch procedures, the postprandial increment of plasma PYY was similar the P-pouch patients and healthy controls (P>0.05). The integrated increment of plasma PYY for 180 minutes following meals was also not decreased in 9-pouch patient group compared with the healthy controls (1,050.0+/-127.8 pmol/l vs. 1146.0+/-150.0 pmol/l, P>0.05). Small intestinal transit time for healthy controls and the patient group averaged 89+/-21 and 117+/-12 minutes (P>0.05). The capacity of the ileal pouch was 372+/-22 ml, and the efficiency of ileal reservoir evacuation was 76 %. CONCLUSIONS: The P-pouch is a new and improved simple modification of the well-established J-pouch procedure, constructed using a single firing of a GIA stapler.
Colloids ; Colonic Pouches* ; Fires ; Humans ; Ileostomy ; Ileum ; Meals ; Peptide YY ; Plasma ; Pouchitis ; Proctocolectomy, Restorative* ; Sulfur

PURPOSE: We evaluated the risk factors for late complications and functional outcome after total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). METHODS: Pre- and postoperative clinical status and follow-up data were obtained for 55 patients who underwent TPC with IPAA between 1999 and 2010. The median follow-up duration was 4.17 years. Late complications were defined as those that appeared at least one month after surgery. For a functional assessment, telephone interviews were conducted using the Global Assessment of Functioning Scale. Twenty-eight patients completed the interview. RESULTS: Late complications were found in 20 cases (36.3%), comprising pouchitis (n = 8), bowel obstruction (n = 5), ileitis (n = 3), pouch associated fistula (n = 2), and intra-abdominal infection (n = 2). The preoperative serum albumin level for patients with late complications was lower than for patients without (2.4 +/- 0.5 vs. 2.9 +/- 0.7, P = 0.04). Functional outcomes were not significantly associated with clinical characteristics, follow-up duration, operation indication, or late complications. CONCLUSION: This study demonstrated that a low preoperative albumin level could be a risk factor for late complications of TPC with IPAA. Preoperative nutritional support, especially albumin, could reduce late complications. Functional outcomes are not related to late complications.
Colitis, Ulcerative ; Fistula ; Follow-Up Studies ; Humans ; Ileitis ; Interviews as Topic ; Intraabdominal Infections ; Nutritional Support ; Pouchitis ; Risk Factors ; Serum Albumin ; Ulcer

PURPOSE:The aim of this study was to compare the early postoperative results and the long-term outcome of restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) in familial adenomatous polyposis (FAP) and ulcerative colitis (UC). METHODS:Thirty patients that underwent IPAA for either FAP (14 patients) or UC (16 patients) at Kyung-Hee University Hospital between January 1987 and December 1999 were studied retrospectively. Either handsewn or stapled anastomosis technique was used in IPAA. Most patients (12 patients in FAP, 16 patients in UC) had a two-stage operation with temporary diverting loop ileostomy and two patients with FAP had a one-stage operation without temporary ileostomy. RESULTS:One patient in the UC group died from sepsis after operation (n=16, 6.25%), but no patients in the FAP group died. Overall operative complications appeared in two patients (14.3%) and four patients (25%) with FAP and UC, respectively. At follow-up (mean, 47.3 months), pouchitis was developed in four patients with UC, but no patients with FAP. The mean daytime stool frequency was 4.5 stools per day in FAP patients and 5.8 stools per day in UC patients (P=0.031), but night-time stool frequency was similar between two groups (1.2 and 1.4 in FAP and UC, respectively; P>0.05). Daytime fecal incontinence was noticed in two patients (14.3%) with FAP and four patients (26.7%) with UC. Night-time fecal incontinence was noticed in three patients (21.4%) with FAP and six patients (40.0%) with UC. CONCLUSIONS:FAP patients tolerated the operation better and had less long-term disability than did UC patients. This suggested that the long-term outcome of IPAA procedure may depend on the primary disease rather than the procedure itself.
Adenomatous Polyposis Coli* ; Colitis, Ulcerative* ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Ileostomy ; Pouchitis ; Proctocolectomy, Restorative* ; Retrospective Studies ; Sepsis ; Ulcer*

BACKGROUND/AIMS: Pouchitis is one of the most common and debilitating complications of a restorative proctocolectomy. We aimed to analyze the features of pouchitis after restorative proctocolecomy and to determine the risk factors related to its development. METHODS: A study was undertaken in 169 patients who underwent total proctocolectomy with ileal pouch-anal anastomosis between July 1989 and December 2003. Pouchitis was defined as change of bowel habit, change in stool consistency, hematochezia or abdominal pain, febrile sensation and/or low-grade fever improved by metronidazole or ciprofloxacin without evidence of infectious disease and sphincter damage. RESULTS: Among the 169 patients, patients with ulcerative colitis were 64, familial and attenuated adenomatous polyposis 44, Crohn's disease 2, and synchronous or hereditary non-polyposis colorectal cancer were 59 cases. Overall, pouchitis occurred in 15.9% of the patients. The incidence was 37.5% in ulcerative colitis, 1% in non-ulcerative colitis, and 50% in Crohn's disease. In ulcerative colitis group, most of the pouchitis (60.9%) occurred within 6 months after the operation and the remainder experienced the first attack within 1 year after operation. Three patients progressed to chronic pouchitis. There was no association between pouchitis rate and sex, history of smoking, steroid use, temporary ileostomy construction, involvement of appendix or proximal colon, and evidence of indeterminate colitis. Only age was significantly related to the occurrence of pouchitis. CONCLUSIONS: Pouchitis developed exclusively in ulcerative colitis than other disease groups. Pouchitis occurred most frequently within 6 months after the operation, therefore, it is important to investigate carefully during one year after the operation in patients with ulcerative colitis.
Adenomatous Polyposis Coli/complications ; Adult ; Colitis, Ulcerative/complications ; Colorectal Neoplasms/complications ; Crohn Disease/complications ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Pouchitis/*etiology ; Risk Factors

The surgical options for ulcerative colitis have developed rapidly in recent years, with emphasis on improving the quality of life by preservation of voluntary defecation and continence while eradicating the disease. In this paper, we have retrospectively analyzed 29 patients with pathologically proven ulcerative colitis who underwent surgical treatment at the Department of Surgery, Seoul National University Hospital between 1980 and 1996. We sought to correlate the changing patterns of the surgical management with their outcomes. The mean age at the time of definitive surgical procedures was 36.7(+/-11.9), and median duration of follow-up was 26 months. The final surgical procedures performed in these patients were ileal J pouch-anal anastomosis (14), total proctocolectomy with either end (7) or continent ileostomy (4), total colectomy with ileorectal anastomosis (1) or Hartmann procedure (2), and partial colectomy (1). Since 1993, we have been performing ileal pouch-anal anastomosis(IPAA), which was performed in all patients except two (one with toxic colitis and the other with disseminated colon cancer). In two patients who underwent partial colectomy and were available for follow-up, there was recurrence of symptoms related to ulcerative colitis. All 11 patients who received total proctocolectomy with either end or continent ileostomy experienced at least one postoperative complication, and 5 required reoperations for management of these complications. Tn particular, 3 out of 7 patients who received total proctocolectomy with continent ileosotmy required removal of the pouch due to pouch related complications. There were two postoperative deaths due to septic complications. On the other hand, while 8 out of 14 patients who received IPAA experienced postoperative complications, all were resolved with conservative management and none required reoperation. The function of ileal J pouch was assessed in 13 Patients at a median duration of 10 months (range : 3~27 months) after restoration of pouch continuity. The mean stool frequency per 24h was 7.6(+/-2.1) and mean nocturnal stool frequency was 1.6(+/-1.5). None of the patients had major incontinence while 7 had occasional spotting of mucous. The remaining 6 patients had normal continence. Only one patient needed antidiarrheal medication and 5 followed a strict diet. Confirmed pouchitis occurred in only one patient. All of the patients who received IPAA were satisfied with their bowel status and the operation. Our results confirm that IPAA is an acceptable surgical option for the management of ulcerative colitis.
Colectomy ; Colitis ; Colitis, Ulcerative* ; Colon ; Colonic Pouches ; Defecation ; Diet ; Female ; Follow-Up Studies ; Hand ; Humans ; Ileostomy ; Metrorrhagia ; Postoperative Complications ; Pouchitis ; Quality of Life ; Recurrence ; Reoperation ; Retrospective Studies ; Seoul ; Ulcer*

Irritable bowel syndrome (IBS) is a complex disorder characterized by abdominal symptoms including chronic abdominal pain or discomfort and altered bowel habits. The etiology of IBS is multifactorial, as abnormal gut motility, visceral hypersensitivity, disturbed neural function of the brain-gut axis and an abnormal autonomic nervous system are all implicated in disease progression. Based on recent experimental and clinical studies, it has been suggested that additional etiological factors including low-grade inflammation, altered gut microbiota and alteration in the gut immune system play important roles in the pathogenesis of IBS. Therefore, therapeutic restoration of altered intestinal microbiota may be an ideal treatment for IBS. Probiotics are live organisms that are believed to cause no harm and result in health benefits for the host. Clinical efficacy of probiotics has been shown in the treatment or prevention of some gastrointestinal inflammation-associated disorders including traveler's diarrhea, antibiotics-associated diarrhea, pouchitis of the restorative ileal pouch and necrotizing enterocolitis. The molecular mechanisms, as cause of IBS pathogenesis, affected by altered gut microbiota and gut inflammation-immunity are reviewed. The effect of probiotics on the gut inflammation-immune systems and the results from clinical trials of probiotics for the treatment of IBS are also summarized.
Abdominal Pain ; Autonomic Nervous System ; Axis, Cervical Vertebra ; Diarrhea ; Disease Progression ; Enterocolitis, Necrotizing ; Hypersensitivity ; Immune System ; Inflammation ; Insurance Benefits ; Irritable Bowel Syndrome ; Metagenome ; Pouchitis ; Probiotics

PURPOSE: This study was performed to assess the complications and functional outcomes after a total proctocolectomy and ileal J-pouch anal anastomosis for patients with ulcerative colitis. METHODS: We reviewed the medical records of 30 patients who had undergone a total proctocolectomy and ileal J-pouch anal anastomosis for ulcerative colitis from 1992 to 1999 in our hospital. We used questionnaires or telephone interviews to assess the functional outcomes of the patients. The median duration of follow-up was 23 months after the ileostomy take down. RESULTS: The mean age of the patients at the definitive operation was 35.9 (+/-11.8). The indications for operation were medical intractability (76.7%), suspicious malignancy (13.3%), perforation (6.7%), and hemorrhage (3.3%). The double stapling method was used in 26 patients and the handsewn method in 4 patients. Of the 30 patients, 23 patients completed the functional analysis. Bowel frequency was 6.6 (+/- 2.6) per 24 hours, with 5.1 (+/- 2.1) in the daytime and 1.4 (+/-1.3) in the night. Fourteen patients (60.9%) had relatively mild incontinence, and four patients (17.4%) had to wear pads, especially at night. Eighteen patients (78.3%) were able to discriminate flatus from feces, and only one patient (4.3%) suffered from perianal irritation. Twelve patients (52.2%) had to restrict their diets, and five patients (21.7%) took antidiarrheal medications. Pouchitis occurred in three patients (13.0%). Sexual dysfunction was noted in four patients (17.4%), and urinary urgency in one patient (4.3%). There was no functional difference between the double stapling method and the handsewn method. CONCLUSIONS: The functional outcomes after ileal J-pouch anal anastomosis for patients with ulcerative colitis were satisfactory, irrespective of the method of anastomosis.
Colitis, Ulcerative* ; Colonic Pouches* ; Diet ; Feces ; Flatulence ; Follow-Up Studies ; Hemorrhage ; Humans ; Ileostomy ; Interviews as Topic ; Medical Records ; Pouchitis ; Surveys and Questionnaires ; Ulcer*