1. VCU DEATH AND COMPLICATIONS CONFERENCE

2.  24 year old male  h/o UC diagnosed 1.5 years ago Treated with multiple agents with minimal efficacy Remicade, Humira, prednisone Up to 10 bowel movements daily Clustered around meals Intermittent abdominal pain Associated with rectal bleeding  Referred for surgical management

3. Clinical History  PMH  Ulcerative pancolitis  Primary sclerosing cholangitis  GERD  PSH:  Bilateral inguinal hernia repairs at 3 months old  Medications  Ursodiol  Prednisone 10mg daily  Cholestyramine  Nexium  Dilaudid  Allergies  NKDA

4. Clinical History  PE  NAD, alert and oriented  RRR  CTAB  Abdomen soft, tender to deep palpation in LLQ, normoactive BS, no hepatosplenomegaly  Labs  Na 140, K 4, Cl 106, CO2 29, BUN 11, Cr 0.77  AST 50, ALT 69, Alk Phos 321, T bili 0.6  WBC 4.5, Hgb 10.8, Plt 263

5. Clinical History  6/21/12  Exploratory laparotomy  Total proctocolectomy with ileal pouch-anal anastomosis  Diverting loop ileostomy

6. Hahnloser, D, et al. Results At Up to 20 Years After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis. British Journal of Surgery. 2007; 94(3)  Prospective, observational study  1885 pts undergoing ileal pouch-anal anastomosis operations from 1981-2000 for chronic ulcerative colitis  Mean age 34.1 years  Mean follow up of 11 years (followed at 1, 5, 10 and 20 years)  Assessed functional outcome, complications and quality of life  Mean number of stools per day before IPAA = 9.5

7. Hahnloser, D, et al. Results At Up to 20 Years After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis. British Journal of Surgery. 2007; 94(3)

9.  Mean daytime stool frequency  Increased from 5.7 at 1 year to 6.4 at 20 years (p<0.001)  Also increased at night from 1.5 to 2 (p<0.001)  Incidence of daytime fecal incontinence  Increased from 5% to 11%  Incidence of night time fecal incontinence  Increased from 12% to 21%

10. Hahnloser, D, et al. Results At Up to 20 Years After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis. British Journal of Surgery. 2007; 94(3)