Background: The majority of children who undergo colectomy for intractable Ulcerative Colitis (UC) receive an ileal pouch anal anastomosis (commonly J-pouch) to restore bowel continuity. After surgery, patients report similar quality of life, physical function and self-esteem compared to healthy peers. The most common J-pouch complications are pouchitis, stricture, leak and fistula. J-Pouch prolapse is a rarely reported complication in adults with paucity of data in children and absent management recommendations. Aim: To describe 5 pediatric IBD patients seen in our center with J-pouch prolapse. Methods: Retrospective chart review of children with UC, J-pouch and pouch prolapse. Reported data include clinical course, time line, management and outcomes. Results: 5 patients were identified, 3 females and 2 males. Median age at UC diagnosis was 12 years (6-14). Median time between diagnosis and colectomy was 16 months (1-42). Median time between colectomy and J-pouch construction was 10 weeks (6-20). Median onset of pouch prolapse (Figure) was 1.5 years (0.5-4). Presenting symptoms included incomplete evacuation, tenesmus, and incontinence. 2/5 patients had transient pouchitis. Pouchoscopy was done in 4/5 children with no significant findings. Ano-pouch manometry study in 2/5 showed abnormal sensation/squeeze pressure and dyssynergistic defecation. Management included fiber supplementation, anti-diarrhea agents, diet modification, change defecation position and biofeedback. On last follow (median 21 months, 4-62) 3 patients had complete prolapse resolution. Remaining 2 patients continue to have frequent episodes of prolapse. Conclusion: Rectal prolapse is an infrequent but problematic complication of the J-pouch in children with variable outcomes. Further study is warranted to better describe incidence, outcome and management options.
