Correct diagnosis of IC has become essential in the "pouch era" for the good outcome of patients submitted to IPAA.
Patients with IC have an increased risk of emergency colectomy. It is still not clear whether this is related to a more aggressive natural history of IC or if the certain diagnosis of IC is more difficult in case of emergency colectomy.
From the practical point of view, one of the most important issues is represented by diagnosis of IC in the surgical specimen; the pathologists should provide a "likelihood" diagnosis in order to help the surgeon's decision-making process. Moreover, this "likelihood" diagnosis is confirmed in many papers by the long-term follow-up in many series.
Late complications of IPAA are represented mainly by small-bowel stenosis or fistula and pouch-anal or pouch-vaginal fistulae. Only the first are pathog-nomonic of mislead CD while the occurrence of anal fistulae not necessarily indicate evolution to CD.
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