Cuffitis

Cuffitis is inflammation at the anal transition zone or "cuff" created as a result of ileal pouch-anal anastomosis (IPAA).^[1] It is considered a variant form of ulcerative colitis that occurs in the rectal cuff.^[2] Cuffitis is a common complication of IPAA, particularly when a stapled anastomosis without mucosectomy procedure has been used.^[2]

Cuffitis
Different regions of Ileal pouch-anal anastomosis
Specialty	General surgery

Signs and symptoms

Symptoms of cuffitis mimic those of pouchitis.^[2] In addition, patients with cuffitis often present with small volume bloody bowel movements.^[2] Often, cuffitis can produce the appearance of bright red blood on tissue.^[1]

Complications

Surgery-associated ischemia may contribute inflammation at the anal transitional zone.^[2]

Patients whose cuffitis is refractory to mesalamine and/or corticosteroids should be evaluated for other disease in the cuff area, such as fistula or anastomotic leaks.^[2] Cuffitis that is refractory to medication can also be a sign of Crohn's disease of the pouch.^[2]

Chronic cuffitis can also contribute to the development of anastomotic stricture.^[2]

Cuffitis that is refractory, Crohn's-related, or is associated with surgical complications can contribute to pouch failure.^[2]

Diagnosis

Definitive diagnose of cuffitis is obtained by endoscopy.^[2]

Treatment

Cuffitis is treated with mesalamine suppositories or topical application of lidocaine or corticosteroid medications.^[2] Systemic medications are rarely used.^[2]