Simple radiographic evaluation of ileoanal pouch volume

PURPOSE: Total colectomy and mucosal proctectomy with ileal reservoir and anal pull-through is used in the treatment of ulcerative colitis or familial polyposis, with one complication being frequent bowel movements. A simple radiographic test to predict frequency of bowel movements and measure spasticity was evaluated. METHODS: Fourteen patients underwent evaluation after ileal reservoir and anal pull-through J-pouch construction. Barium sulfate suspension was instilled into the pouch via the anus in the standing position until reflux flowed into the small intestine proximal to the pouch and patients felt the urge to defecate. Total volume infused (VOLtot), volume to reflux (VOLrflx), and volume voided (VOLvoid) were measured. RESULTS: VOLvoid and the 'voiding efficiency' (VOLvoid/VOLtot) correlated significantly with stool frequency (R = -0.744, P < 0.002 and R = -0.754, P < 0.002, respectively). Time from operation was correlated with VOLvoid and stool frequency (R = -0.723, P < 0.003 and R0.573, P < 0.032, respectively). CONCLUSIONS: The addition of quantitative measurements to this radiographic test gives useful information about pouch performance. Furthermore, the data imply that spasticity, as measured by voiding quantum and efficiency, rather than actual pouch volume is a major determinant of bowel movement frequency.