A stapled ileoanal anastomosis without mucosecto-my is done routinely at the level of the anorectal junction; hence, a 1- to 2-cm strip of rectal columnar cuff is retained. Some degree of persistent inflammation of the rectal cuff is common. This may be severe enough to cause local symptoms of bleeding, burning and urgency in up to 15% of patients [73]. There may be disordered evacuation with frequency. Diagnosis, as with pouchitis, is based on clinical symptoms, endoscopy and histology taken from the rectal-cuff mucosa. In some patients, cuffitis coexists with pou-chitis. Treatment consists of topical corticosteroids or 5-aminosalicylate. A few patients may need further systemic treatment or a salvage surgery [74]. In our group of patients, three (3%) were diagnosed with cuffitis. All were treated with corticosteroids or 5-aminosalicylate enemas with good response; no one needed a salvage operation.

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