Ileoanal Pouch Construction for Inflammatory Bowel Disease

Obi, Megan; Holubar, Stefan D.

doi:10.1097/dcr.0000000000003329

Diseases of the Colon &Amp; Rectum

2024

DOI: 10.1097/dcr.0000000000003329

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Ileoanal Pouch Construction for Inflammatory Bowel Disease

Megan Obi,

Stefan D. Holubar

Abstract: A 25-year-old nulliparous woman with ulcerative colitis (UC) returns to the clinic 2 months after undergoing elective laparoscopic total abdominal colectomy for medically refractory pancolitis. She has been tapered off corticosteroids, upadacitinib has been discontinued, and she has gained 10 pounds. She reports no history of perianal disease. Colectomy pathology revealed diffuse, chronic, severely active colitis with superficial ulceration and inflammation without terminal ileal inflammation or dysplasia. She… Show more

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2024

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Cited by 2 publications

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Pouch Salvage of Long Rectal Cuff Syndrome: Excision of Retained Rectum and Mesorectum With Conversion to Ileoanal Anastomosis

Goldenshluger,

Rieder,

Holubar

2024

Inflammatory Bowel Diseases

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Pouch Salvage of Long Rectal Cuff Syndrome: Excision of Retained Rectum and Mesorectum With Conversion to Ileoanal Anastomosis

Goldenshluger,

Rieder,

Holubar

2024

Inflammatory Bowel Diseases

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Unraveling Twisted Pouch Syndrome: A Narrative Review of Classification, Diagnosis, Treatment, and Prevention

Holubar

2024

Inflammatory Bowel Diseases

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Background We recently described a cluster of symptoms known as twisted pouch syndrome that rarely affects patients with ileoanal pouches. Herein, we present a narrative review in which we describe the diagnosis, treatment, and prevention of twisted pouch syndrome, with a focus on a simple classification schema. Methods Diagnostic signs from endoscopic and radiological examinations, treatment, and prevention strategies are presented. Results Patients with twisted pouch syndrome suffer from a triad of obstructive symptoms, erratic bowel habits, and pain which may be severe, debilitating visceral pain, all in the setting of a mechanical pouch abnormality. Diagnostic modalities include imaging, careful pouchoscopy, functional testing, diagnostic laparoscopy or laparotomy, and recently 3-dimensional pouchography. Classification of twisted pouch syndrome is based on the location and degree of rotation of the pouch and its mesentery. Outlet twists may result when the distal pouch rotates >90° to 360° clockwise inadvertently during anastomosis; when only the distal most pouch is twisted, it results in an iris-like deformity of the pouch outlet, or when the distal half of the pouch is twisted, a mid-pouch stenosis and an hourglass-shaped pouch may result. Inlet twists are either a full 360° (mesentery posterior), unintentional 180° (mesentery anterior), or 90° counterclockwise twists. Both inlet and outlet twists are fixed deformities and may only be reduced by disconnecting the entire pouch from the anus. If they result in twisted pouch syndrome, a redo pouch procedure or pouch excision is required to reduce the twist; 90° counterclockwise twists may undergo pouch inlet transposition. Adhesive twists result when the pouch becomes fixed in the pelvis in an abnormal configuration, such as when the efferent limb becomes twisted underneath the afferent limb secondary to an occult tip of the J leak, and may be reduced by pelvic adhesiolysis with or without pouch revision. Conclusions Pouches may rarely be inadvertently twisted during construction or twisted owing to adhesive disease or leaks. A high index of suspicion is needed to establish the diagnosis. We present a simple classification of twisted pouch syndrome that may aid in the prevention and recognition of these often difficult to diagnose postoperative complications.

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Ileoanal Pouch Construction for Inflammatory Bowel Disease

Cited by 2 publications

References 13 publications

Pouch Salvage of Long Rectal Cuff Syndrome: Excision of Retained Rectum and Mesorectum With Conversion to Ileoanal Anastomosis

Pouch Salvage of Long Rectal Cuff Syndrome: Excision of Retained Rectum and Mesorectum With Conversion to Ileoanal Anastomosis

Unraveling Twisted Pouch Syndrome: A Narrative Review of Classification, Diagnosis, Treatment, and Prevention

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