ABSTRACT

Surgical treatment of the ulcerative colitis is abdominal procto-colectomy and ileal pouch anal anastomosis. A J-shaped pouch is created from the terminal ileum to serve as a reservoir function of the rectum. Early endoscopic evaluation of the pouch can predict surgical complications and the long-term pouch outcome. The owl’s eyes image in the proximal part of the pouch is an indicator that it is technically well constructed.

Diagnosis

Surgical treatment of the ulcerative colitis involves abdominal proctocolectomy and ileal pouch anal anastomosis. A 37 years of male patient underwent surgery for treatment-resistant disease in March, 2025. Eight weeks after the surgery, the ileal pouch was evaluated endoscopically before the protective ileostomy takedown.

Surgical Technique

Following resection of the entire colon and rectum of the patient, a J-shaped pouch was created from the terminal ileum to serve as a reservoir function of the left colon. Forty centimeters of the small bowel (20-20 cm) were brought together and stapled to create a pouch (Figure 1). Subsequently, the pouch was anastomosed to the anal canal to maintain intestinal continuity.

Outcome

Endoscopic evaluation of the pouch can predict long-term outcomes (Video 1). The owl’s eye image in the proximal part of the pouch is an indicator that it is technically well constructed (Figure 2). The distorted appearance of the “beak” portion of the owl’s eyes’ is a risk factor for pouch failure (1).