I had my J-Pouch created on 22nd Feb this year. The take down or connection surgery will be done as and when I am fit and ready.

Since the surgery I have been suffering from infections. I had two wound infections which eventually cleared up on their own (after they had been drained). I have also two infections in the pouch which I can only assume is pouchitis albeit the pouch has not yet been connected.

On both occaisions I got myself onto antibiotics (cyclofloxacin) and they worked. Or they did the first time after about 10 days. I am still treating the second infection.

Can anyone let me know if this infection problem common prior to even having the pouch connected? And if this is an indication of some issue with the surgery.

I recently had a pouchogram and this all looked good.

I would very grateful for any comments as I am starting to worry that my pouch, when connected, will be very troublesome.

Thanks

Hi Fenners,
So sorry you're experiencing this, but I did a quick search and found alot of discussion about this subject on previous posts which might be helpful to you. If you click on the blue "Find" tab you'll see a drop down box. Type in "pouchitis before takedown" and you'll find the previous posts on this subject. Maybe you'll find some reasurrance there. Hope this helps!

Hi Fenners,

it is possible that you have pouchitis even though your pouch is not connected.

An infection is totally differenent to pouchitis.

Not sure what a pouchogram is (im in Australia so different terminology). But if the scope of your pouch was all clear, then may not be pouchitis.

Cheers.
Jerry

Many thanks for your replies.

Good point about an infection not being pouchitis. I need to find out from my surgeon which one I have (if it is possible to know).

In the UK a pouchogram is where they fill the pouch via the back passage with a fluid which is detected on a real time x-ray device that displays images on a TV. This test is done to see is the pouch has any leaks and is ready for the take down proceedure.

Update on pre-take down pouchitis.

I spoke with the Professor today who carried out my surgery. He has been doing this surgery since it's early days and has done well over 300 of these proceedures and with his team is meant to be world leading in this area.

He said that you can not get pouchitis prior to the take down operation and the discharge that I am getting (albiet pale greeny in colour) is not puss or similar. And that small about of fluid will be discharged from the pouch at this stage.

If this is the case then has anyone had discharge prior to the take down operation?

Thanks

i have blood and or mucous discharge several times a day, often followed by a little but if pain.

My son had the same thing. He had his pouch created Nov of last year and he is scheduled for takedown on the 21st of this month. His pouchitis is called Diversion Pouchitis meaning the part not hooked up is not getting nutrients or good bacteria which will cause the inflamation.

I am still getting pre takedown pouchitis and so it is interesting to learn from diehl about diversion pouchitis. My surgeon has never mentioned this condition and just said getting discharge was normal.

Not accepting his view I took some anti-biotics and the discharge or fluid stopped. A few weeks later it returned and so back onto anti-biotics and the fluid stops. So it must be inflamtion of some kind and not some regular output.

Anyway, I am going onto the probiotics now (VSL#3) and once the effects of the anti-biotics stop hopefully the VSL will stop the pre take down inflamation.

I think Jan can chime in but probiotics won't do much unless you had your takedown since the good bacteria won't get to the pouch. Do a search on the internet for Diversion Pouchitis or Diversion colitis. My son's surgeon called after about a week from my son's last scope and he said that he spoke to alot of experts from the Cleveland clinic and they said he needs to have his takedown it will clear this up.

This message has been edited. Last edited by: diehl2229,

You can get real pouchitis before take-down, but it is pretty rare. Diversion pouchitis occurs too. It is difficult to say which one a person has, but if you can't clear it up with antibiotics, it is likely diversion.

Probiotics are another controversial topic in regard to pouchitis before take-down. Conventional wisdom would say that their effect is topical and if you are diverted, the probiotics can't get to where they need to so they can colonize and protect the mucosa. If you have a loop ileostomy, some may get through and find their way to the pouch. But what is more amazing is that I have read studies indicating a systemic effect from probiotics, so I suppose that it is possible that oral probiotics might help a diverted pouch. I just wouldn't bet a lot of money on it. I go for a probiotic enema before taking expensive oral VSL#3 for a diverted pouch.

Jan

Many thanks for your replies on this subject. All what you say makes sense.

My surgeon kind of insists that the output I am getting is due to waist getting into the pouch via the loop ileostomy. However, the output is intermitent and if I take antibiotics for three days the output stops for a couple of weeks or so. So it is imflamation in the pouch of some kind.