Mistakes in ... Booklet 2020 - 22

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a vitamin A or B12 deficiency. Furthermore,
patients with pouchitis may be at risk of having
lower levels of calcium, total cholesterol,
triglycerides, vitamin E and iron.44,45 It is
therefore important that anyone who undergoes
proctocolectomy is advised to consider eating
foods rich in these vitamins and minerals to keep
levels normal.
Caution must also be exercised with respect
to fluid balance in a patient who has a pouch.
Normal stool frequency can be four to eight
times in a 24-hour period, and a great deal higher
when active pouchitis is present. Patients can
become dehydrated46 and electrolytes depleted,
contributing to fatigue. It can be helpful to assess
fluid balance by checking the urinary sodium
level, and consider the addition of electrolyte
mix and antidiarrhoeal agents to reduce fluid
loss. Guidance from an experienced dietitian is
helpful.

Mistake 10 Managing patients with pouch
dysfunction outside a specialist centre
Restorative proctocolectomy is an operation that
is designed to improve overall quality of life and
remove the need for an ileostomy; however, poorly
functioning pouches may impact on a patient's
life in multiple ways, resulting in nutritional,
psychological, physical and emotional problems.
It is therefore essential that a patient who has a
pouch is given access to a broad range of
healthcare professionals who have the skills and
experience necessary to support their various
needs. If a pouch starts to function poorly, it is
vital that early discussions are held with the
multidisciplinary team so that all management
options, including surgery, are considered.
Specialist pouch nurses, gastroenterologists,
surgeons and dietitians are needed to ensure
effective service delivery. Joint medical and
surgical clinics can help to achieve a holistic
review of a patient's quality of life and offer the
full range of treatment options. As pouch surgery
is not frequently performed, we recommend
that, whenever possible, pouch care should be
centralised to units that perform a high volume
of these operations and have the healthcare
support staff and infrastructure needed to
manage pouch-related problems. Furthermore,
patients should have a point of contact, much
like an 'IBD nurse', so they can discuss problems
with their pouch and be directed to the right
services early.
References
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2. Sandborn WJ. Pouchitis: definition, risk factors,
frequency, natural history, classification, and public
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