1. A Proposed Classification of Ileal Pouch Disorders and Associated Complications After Restorative Proctocolectomy 
Bo Shen, Feza H. Remzi, Ian C. Lavery, Bret A. Lashner, Victor W. Fazio 
Clinical Gastroenterology and Hepatology 
Volume 6, Issue 2, Pages (February 2008)
DOI: /j.cgh
Copyright © 2008 AGA Institute Terms and Conditions

2. Figure 1
Pouch leaks: Schematic illustration of pouch leaks at the tip of “J” (A2), pouch body (A3), and pouch-anal anastomosis, leading to pelvic sepsis (A4), pouch-vaginal fistula (A5), and pre-sacral fluid collection (A1). Endoscopic view of a leak at the tip of “J” (B).
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

3. Figure 2
Pouch sinuses: Schematic illustration (A) and contrasted radiography of a distal pouch sinus at the anastomosis resulting in contrast collection at the presacral space (C), arrow. Endoscopic views of sinuses at anastomosis (B).
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

4. Figure 3
Afferent limb syndrome causing partial bowel obstruction: Schematic (A) and endoscopic (B) views of a sharp angulation at the junction of the neo-terminal ileum and pouch inlet, which prevents endoscopic intubation of the neo-terminal ileum and reflux of contrasted enema to the distal small bowel (C).
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

5. Figure 4
Efferent limb syndrome causing partial bowel obstruction: Schematic (A) and contrasted X ray views of an excessively long efferent limb (arrow) in a S pouch, before (B) and after (C) surgical correction with pouch advancement.
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

6. Figure 5
Portal vein thrombosis after restorative protocolectomy. Portal vein thrombosis with cavernous formations and collaterals on CT scan (A) which is associated with gastric varices on upper endoscopy (B).
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

7. Figure 6
Ischemic pouchitis: Endoscopic manifestation of inflammation and ulcers only present in the afferent limb half of J pouch (B). Mesenteric stretch during ileal pouch-anal anastomosis (A) may be a contributing factor.
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

8. Figure 7
Cuffitis: Endoscopy of normal cuff (A) and severe cuffitis (B).
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

9. Figure 8
Foreign body granuloma (arrow) on histology (A) from mucosal biopsy along the suture line (B).
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

10. Figure 9
Clues for the distinction between backwash ileitis from diffuse pouchitis and Crohn’s ileitis. In backwash ileitis from diffuse pouchitis, there was diffuse distal ileitis (A) with widely a patent pouch inlet (B), continuously from diffuse pouchitis (C). In Crohn’s ileitis, there were discrete ulcers in the neo-terminal ileum (D) in the setting of ulcerated stricture at the pouch inlet (E) and discrete pouch ulcers (F), in the absence of use of NSAIDs.
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

11. Figure 10
Pouch vaginal fistula from Crohn’s disease: Fistula opening at the distal pouch (A) and vagina (B), treated with seton placement (C).
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

12. Figure 11
Pouch polyps: Schematic illustration of polyp lesions in the pouch and cuff (A). Endoscopic views of polyps in the pouch (B) and cuff (C).
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

13. Figure 12
Endoscopy, histology and CT scan in a 35-year-old patient with poorly differentiated adenocarcinoma in both pouch (A, B) and anal transitional zone/cuff (D, E), with liver (C) and intra-abdominal lymph node (F) metastases.
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

14. Figure 13 Diagnostic Algorithm.
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions