Which best describes the J-pouch after proctocolectomy?

• A. It uses an ileal pouch attached to the anal canal with the rectum removed
• B. It uses the colon to form a pouch attached to the anus
• C. The anal canal is removed entirely
• D. The anal canal remains and an ileal pouch is attached to it

Answer: (D)

The key idea is that after a restorative proctocolectomy, a reservoir from ileum is created and attached to the remaining anal canal, so stool can be stored and evacuated through the anus. The anal canal stays in place and serves as the outlet for the ileal pouch, while the rectum is removed. This connection—an ileal pouch attached to the intact anal canal—defines the J-pouch configuration and how it functions to preserve continence. Describing it as simply removing the rectum is less informative about the essential relationship between the ileal pouch and the remaining anal outlet.