Cuffitis

Cuffitis
Different regions of Ileal pouch-anal anastomosis
Specialty	General surgery

Cuffitis is inflammation at the anal transition zone or "cuff" created as a result of ileal pouch-anal anastomosis (IPAA).[1] It is considered a variant form of ulcerative colitis that occurs in the rectal cuff.[2] Cuffitis is a common complication of IPAA, particularly when a stapled anastomosis without mucosectomy procedure has been used.[2]

Signs and symptoms

Symptoms of cuffitis mimic those of pouchitis.[2] In addition, patients with cuffitis often present with small volume bloody bowel movements.[2] Often, cuffitis can produce the appearance of bright red blood on tissue.[1]

Complications

Surgery-associated ischemia may contribute inflammation at the anal transitional zone.[2]

Patients whose cuffitis is refractory to mesalamine and/or corticosteroids should be evaluated for other disease in the cuff area, such as fistula or anastomotic leaks.[2] Cuffitis that is refractory to medication can also be a sign of Crohn's disease of the pouch.[2]

Chronic cuffitis can also contribute to the development of anastomotic stricture.[2]

Cuffitis that is refractory, Crohn's-related, or is associated with surgical complications can contribute to pouch failure.[2]

Diagnosis

Definitive diagnose of cuffitis is obtained by endoscopy.[2]

Treatment

Cuffitis is treated with mesalamine suppositories or topical application of lidocaine or corticosteroid medications.[2] Systemic medications are rarely used.[2]

References

1. "Pouchitis: Causes, Symptoms & Treatment | Cleveland Clinic". my.clevelandclinic.org. Retrieved 2016-12-12.
2. Shen, Bo (2016-12-12). "Diagnosis and Management of Postoperative Ileal Pouch Disorders". Clinics in Colon and Rectal Surgery. 23 (4): 259–268. doi:10.1055/s-0030-1268252. ISSN 1531-0043. PMC 3134805. PMID 22131896.