A 35-year-old patient with a long history of inflammatory bowel disease is being evaluated for surgical treatment. The surgical team discusses the potential for restorative proctocolectomy with ileo-anal pouch, considering the underlying diagnosis and suitability for the procedure.
Which of the following conditions is a contraindication for restorative proctocolectomy with ileo-anal pouch?
A. Ulcerative colitis
B. Crohn’s disease
C. FAP (Familial Adenomatous Polyposis)
D. Indeterminate colitis
Correct Answer: B. Crohn’s disease
Explanation:
Restorative Proctocolectomy with Ileo-Anal Pouch:
– This is a surgical procedure in which the entire colon and rectum are removed, and a new reservoir (pouch) is created from the small intestine and connected to the anus. This procedure aims to maintain bowel continuity and allow the patient to pass stools normally through the anus, preserving continence.
Crohn’s disease:
– Restorative proctocolectomy with ileo-anal pouch is contraindicated in patients with Crohn’s disease. Crohn’s disease can affect any part of the gastrointestinal tract and is characterized by transmural inflammation, which increases the risk of complications such as pouchitis, fistulas, and recurrent disease in the pouch. Therefore, patients with Crohn’s disease are not ideal candidates for this surgical procedure.
Explanation of Incorrect Options:
Ulcerative colitis:
– Ulcerative colitis is a suitable indication for restorative proctocolectomy with ileo-anal pouch. This procedure is often performed for patients with ulcerative colitis because the disease is limited to the colon and rectum, and removing these structures can effectively cure the disease and restore bowel continuity.
FAP (Familial Adenomatous Polyposis):
– Familial Adenomatous Polyposis (FAP) is also an indication for restorative proctocolectomy with ileo-anal pouch. Patients with FAP have a high risk of developing colorectal cancer, and this procedure helps remove the colon and rectum while preserving continence.
Indeterminate colitis:
– Indeterminate colitis refers to cases where it is difficult to distinguish between ulcerative colitis and Crohn’s disease based on clinical, endoscopic, and histological findings. While it presents a more complex decision-making scenario, indeterminate colitis is not an absolute contraindication for restorative proctocolectomy with ileo-anal pouch, unlike Crohn’s disease.
Given these considerations, Crohn’s disease (Option B) is the contraindication for restorative proctocolectomy with ileo-anal pouch due to the risk of recurrent disease and complications in the ileo-anal pouch.