Stefan Holubar, MD, on 3D Pouchography

Dr Holubar explains how three-dimensional imaging of pouches can help to refine diagnoses of pouch complications. 

Stefan Holubar, MD, is a colorectal surgeon and director of research in the Department of Colorectal Surgery at Cleveland Clinic in Cleveland, Ohio.

Hi, I'm Stefan Holubar from Cleveland Clinic Department of Colorectal Surgery, where I’m the director of research and IBD subspecialist, and I'm going to talk to you about a really new, nice breakthrough technology that was recently reported in the Journal of Crohn’s and Colitis called 3D pouchography. Basically what we did was we looked at CAT scans and noticed that the staple lines cross multiple different cuts on a CAT scan and this is really important, specifically for mechanical pouch complications, specifically twisted pouch syndrome and pouch ovuluses. And what we realized is that we could import the CD and DICOM data into specialized software, which was being used by cardiology for 3D reconstruction. And we could very easily subtract out all the bone and soft tissue, leaving just the hyper intense staple lines. And then that gets exported to a 3D AVI movie that you can then rotate and look at the pouch model of the staple lines in 3 dimensions.

And we have found that it's really a breakthrough technology for trying to understand the 3-dimensional morphology of pouches at this point of the staple lines and we're currently working on expanding it to include the lumen of the bowel wall, which is an order of magnitude more difficult. So I hope you will look up 3D pouchography and consider it as a go-to technique the next time you have a patient with a difficult to diagnose mechanical pouch complication.