The Pouch Corner: Perianal Fistulas and Ileal Pouches: Examining Fistulas Before and After Pouch Creation

Lay Summary Patients with ulcerative colitis (UC) and Crohn’s disease (CD) proctocolitis are candidates for an ileal pouch-anal anastomosis (IPAA), provided they do not suffer from complex perianal fistulas or small bowel inflammation. UC patients who develop a simple perianal fistula may still be candidates for an IPAA; however, patients with complex perianal fistulas are precluded from having an ileal pouch. After an IPAA, patients may develop perianal fistulas that arise acutely from a technical complication or an anastomotic leak, or as late-onset fistulas as a result of CD-like inflammation of the pouch.