TECHNIQUE: MR of the pelvis WITH AND WITHOUT intravenous gadolinium.

COMPARISON: Comparison to multiple prior studies the most recent one
CT abdomen and pelvis 3/23/12

CLINICAL INFORMATION: Status post ileal pouch-anal anastomosis.

Suboptimal study due to motion.
Post operative changes to the pelvis with distortion of normal anatomy.
The uterus is not visualized.

There are multiple dilated bowel loops in the pelvis with gas and fluid.
Air and gas within what is believed to represent a surgical pouch. There
is thickening and enhancement surrounding the distal rectum/upper anal
canal to the anastomosis with significant enhancement and small amount of
fluid in the posterior pararectal space.

No perineal abscesses.

Visualized osseous structures and pelvic walls show no gross abnormality
except for post operative changes to the lower anterior abdominal wall.


Suboptimal study due to motion.Extensive postoperative changes pelvis
with distortion of normal anatomy.

Status post ileal pouch-anal anastomosis anastomosis with abnormal
enhancement and thickening surrounding the surgical anastomosis
extending to the upper anal canal. Small amount of fluid along the
posterior pararectal space. Anastomotic leak cannot be excluded.

RECOMMENDATION: Gastrografin enema.
Original Post
enhancement and thickening surrounding the surgical anastomosis
extending to the upper anal canal. Small amount of fluid along the
posterior pararectal space. Anastomotic leak cannot be excluded.

The above is the part that is what you focus on. The rest is mostly description of normal stuff and how the study was done. The bad news is that because you moved during the scan, it is not as good of an image as they would like (or your guts were in too much motion).

Basically, it looks like cuffitis and a fluid collection behind the pouch. They cannot determine if there is a leak or it is an old collection (prior leak, now sealed off). The posterior rectal space is what is also called presacral area, and a common place for a presacral abscess to form.

Hope that helps.

Jan Smiler
Thank you Jan. As soon as they put the contrast in, my bowels started going crazy. My butt was firmly placed, so I am thinking that is what they are referring to.

I am besides myself. I have had a leak before, a revision, and multiple issues. I have posted before how my pouch is not functioning, and my surgeon doesn't want to do surgery. I have considered going back to an ostomy, but so don't want to, and have done everything I could to avoid this. I think this may mark the end, and my decision power taken away.

What do you think?
How about pouch advancement, removing your cuff? Have you consulted with a different surgeon? This does not sound like there would be an easy fix. There never is an easy fix. Only you can decide when enough s enough.

Jan Smiler
Last edited by Jan Dollar
I have not, surgeon so emotionally tells me he does not want to take the chance with another surgery, that I worry, others will rush in without knowing my history. I think about it, then get frightened. My pouch is completely dysfunctional, very stretched out. I have to practically stand on my head to empty. I think I would need a total pouch redo, which again, with my history is so scary. I forgot to mention that I have been on Cimzia for 8 months, and xiflaxin, flagyl, and cipro for 5 months. I also use hydrocortisone suppositories daily. I am in constant pain, and now my wbc is at 16000. It was 12000 2 weeks ago, so I think this "leak" must be new since the wbc is rising. I am so lost, and think there is no hope for me!!I want to crawl into bed an never come out! If I didn't have my children to take care of, I think I would! I am just at my end!

Sorry, don't mean to be such a downer, I'm usually not....
Cimzia? OK, so you must have Crohn's. Pouch revisions, redos, whatever, would be contraindicated, regardless of how many surgeons you see. Cimzia is not used for UC or pouchitis.

I understand your dilema now. Basically, your choice is to deal with your dysfunctional pouch with medical intervention or opt for pouch removal and ileostomy.

Not much of a choice. You just have to decide which way the balance is tipped for you.

Jan Smiler
Yes. They changed my diagnosis about 10 months ago. I had what we all thought was UC for 23 years.

I just wish I could go to sleep and wake up however it is meant to decision on my part..I know, a fantasy world!

Thanks for helping me, and everyone else on this site. You are very special, and I appreciate all you do!
Bummer! You are definitely between a rock and a hard place, but oly you can decide what risks you are willing to assume. We all could potentially face the same dilema, since there is no such thing as a 100% certain UC diagnosis. We all just hope for he best.

Good luck deciding. At leadt we are here when you need to vent...

Jan Smiler

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