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Pouch dysfunction may be present in up to 15% of patients, depending on the symptoms investigated. When it is suspected, the first step is to investigate the reason behind it: pouchitis, irritable pouch, chronic pelvic sepsis, pelvic desmoid tumor, between others. Dysfunction may also be caused by mechanical complications as outlet obstruction. In this 12th episode of the Ileal Pouch Series, Dr. André d'Hoore MD PhD talks about the diagnostic pathway for patients presenting with pouch dysfunction and the different treatment options.