We read the article ‘Pouchitis: a practical guide’1 with great interest, and support the authors’ efforts to simplify the management of patients with ileal pouch dysfunction. In particular, we agree that a diagnosis of pouchitis must not be presumptive, but should be made based on clinical, histological and endoscopic findings, and that pouch complications are best defined as a deviation from normal pouch function. Although their well considered algorithm is comprehensive from a gastroenterologist's perspective, Steinhart and Ben-Bassat1 have rather skated over crucial elements that inform a surgeon's practice. Although pouchitis is the most common long-term complication of ileal pouch–anal anastomosis (IPAA), there are several ‘surgical’ entities that have similar presenting symptoms and signs, such as pelvic sepsis, fistulae, abscesses, strictures, sinuses and cuffitis. The timely diagnosis and treatment of these …