Polyps in J-pouch

A key concern is the presence of polyps close to the anal sphincter.  If their removal would significantly compromise the function of the sphincter, the result could be incontinence, not a nice picture. Does your son have FAP?  Please feel free to send me a PM.  My situation had similarities to your son's.

Thank you for your reply. I am not sure of FAP, he had colon cancer twice and they had to remove his entire colon except for 1 cm, which i think is the rectal cuff. Now with these polyps showing up , i am not sure what the next steps would be , can they remove this jpouch too, will he survive ? I am just in a really bad place thinking of all the what if’s, which I know not to do.

If his rectal cuff needs to be removed because of a recurrence (please remember that this is a fear rather than a current problem) then there are multiple options, all of which permit surviving (and thriving). Option 1, which requires a very experienced surgeon, would be to remove the rectal cuff and hand-sew the pouch directly to the anal canal. This is called a “pouch advancement” procedure. Option 2, if the J-pouch ought to be removed, would be to create a “continent ileostomy,” a K-pouch or BCIR. These create an opening in the abdomen but don’t require an external plastic bag. The internal pouch is emptied with a small catheter several times daily. BillV (above) is one of our members who has thrived with this solution. Option 3, again if the J-pouch has to be abandoned, is a conventional end ileostomy. An end ileostomy involves an external appliance (bag), and people generally do just fine with ileostomies, but it requires accepting a more obviously altered body. Removing a J-pouch is sometimes surgically tricky, so again a surgeon experienced in the procedure is a very good idea.

It would be best to find out if he has FAP, because that requires medical guidance and thoughtful attention over time. FAP stands for familial adenomatous polyposis, and causes a substantial tendency to form polyps, and they have to be monitored and managed. Like a possible cancer recurrence this is a fear rather than a fact right now.

Thank you for taking time explaining all of these. I know at this point I am just speculating, but it really helps to see there are options if the time comes( hoping it doesnt). I hear the surgeons at Duke are one of the best, I am hoping they will be able to make the right decisions for him. But having this information will help me understand all the options better and talk to my son if the time comes. Thank you!!!