Hi. My daughter's pouch actually tore away at the area near the rectum where it had been stapled due to so much inflammation in that area and steroid use. So in answer to your question, yes it did finally heal and she had her takedown. The surgeon had tried to stitch it closed or staple it again and it just didn't work, so she had to wait to have her take down. I think it was an extra 6 weeks.

This does occur at times. I lifted this info from a CC article that talks about pouch leaks and healing over time.

Pouch Leaks

The overall leak rate after IPAA ranges between 5% and 18%.4,7,18,19,20 Leaks may develop from the pouch-anal anastomosis, from the pouch itself, or from the tip of the J pouch. Anastomotic tension and bowel ischemia are the two main factors associated with high leakage rates after IPAA. Elderly patients, males, and those on corticosteroids are also at greater risk for developing leaks.

Pouch-anal anastomotic leakage occurs more frequently in patients undergoing IPAA without a diverting ileostomy, according to the experience from our institution. Sugerman and group, on the other hand, reported a lower anastomotic leak rate after one-stage stapled ileoanal pouch procedure. They advocated the one-stage procedure for severely obese patients with ulcerative colitis or familial adenomatous polyposis, to eliminate the related tension on the anastomosis.14

Anastomotic leaks may be asymptomatic “sinuses” that originate from the anastomosis, and they are most often diagnosed at the time of pouchography when the patient returns for the take down of the ileostomy. Such radiologically detected leaks represent incomplete healing of the anastomosis or the ileal pouch. The leaks will usually heal spontaneously by deferring the closure of the ileostomy for a few months. A repeat Gastrografin enema should be performed 3 to 6 months later for evaluation. If no abscess cavities are present and the sinus track leading from the anastomosis is narrowed or obliterated, then ileostomy closure can be performed.

In a symptomatic patient who is stable, not septic, and has no peritonitis, initial treatment for a leak should include intravenous antibiotic therapy, drainage, and bowel rest. Antibiotic coverage should include both aerobic Gram-negative and anaerobic organisms. In the presence of a sizeable pelvic abscess, percutaneous drainage under computed tomography (CT) guidance may prevent the need for relaparotomy. When the drain output decreases to less than 100 cc over 24 hours, a tube sinogram provides useful information that can help the surgeon decide whether to remove the drainage tube.

In some instances, a minor leak results in a small presacral collection. Examination under anesthesia allows evaluation of the abscess collection and passage of a transanal catheter into the cavity for daily irrigation. The catheter may be safely removed when there is clinical and radiologic evidence of resolution of the abscess cavity.

Bowel rest combined with frequent clinical evaluation and assessment is instituted initially in all symptomatic cases. When there are signs of clinical improvement, the patient may be advanced to oral liquids and eventually resume a normal diet.

Emergent surgical intervention may be required for patients who are treated with nonoperative therapy whose signs and symptoms worsen and those with generalized peritonitis or high-output pouch-cutaneous fistulas, although this is uncommon, especially in the presence of a diverting ileostomy. The surgical intervention should be preceded by immediate fluid resuscitation and administration of intravenous broad-spectrum antibiotics.

In patients with a diverting ileostomy and peritoneal contamination, thorough peritoneal lavage with copious amounts of warm saline followed by placement of wide-bore drains are the cornerstone of surgical therapy. In nondiverted patients with peritoneal contamination and small anastomotic defects, a case may be made for performing a diverting loop ileostomy after peritoneal lavage and drainage. In these circumstances, either an end ileostomy or loop ileostomy with over-sewn distal limb would be our preferred techniques to avoid passage of stool into the efferent limb with continued sepsis through the anastomotic defect.

We recently presented our experience with leaks that originated from the tip of a J pouch after RP. Among 1309 patients, there were 14 (1%) who had a leak from the tip of the J pouch. Steroid dependency was the only risk factor for this problem. We suggested using CT, pouchogram/fistulogram, and/or pouchoscopy as the diagnostic tools. In a stable patient who presents before ileostomy closure and with no peritonitis, the initial treatment can consist solely of CT-guided drainage. Surgical repair of the leak is performed at a later date and involves suture ligation or restapling of the J-pouch tip. The ileostomy may be closed at the time of the repair or deferred. In a nondiverted patient or one who presents after ileostomy closure, laparotomy, drainage, and a diverting ileostomy should be performed as the initial treatment. Surgical repair of the leak should be attempted since none of these leaks healed conservatively, and ileostomy closure can be performed either concurrently or at a subsequent setting.22

Sinuses or leaks that persist after treatment may suggest the presence of underlying Crohn's disease.

I had a pin hole that took six months to heal on its own. I had multiple xrays done over the months and was extremely frustrated. The doctor finally decided to put me to sleep and go inside and glue it shut. They woke me an hour later and said they couldn't find the hole. I was pissed off!!!!! They said, you don't understand, we think it has healed on its own and lets schedule take down next week. That's the short version of the story. Your body will fix itself or elmer's glue will. Keep your chin up, enjoy the convenience of the bag, you won't have the leach for long.

Examination of my pouch before take-down did not show any issues, but fistula-like growths all over the pouch were found during my take-down surgery! Eek! Crohn's! They revised the stoma, which had been giving me fits, and I awoke from surgery in pain -- and to the words from my partner -- "It didn't go well." This was right before Christmas, and I too had looked forward to the new year without an ostomy. Instead I had to prepare myself for my first of three Remicade infusions . . . and I was terrified!

I finally had my take-down in April, on tax day . . . 2003.