Pouch Volvulus in Patients Having Undergone Restorative Proctocolectomy for Ulcerative Colitis: A Case Series

Landisch, Rachel M.; Knechtges, Paul; Otterson, Mary F.; Ludwig, Kirk; Ridolfi, Timothy J.

doi:10.1097/dcr.0000000000001050

Cited by 20 publications

(23 citation statements)

References 17 publications

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“…Two publications were in abstract form [22, 27], four were letters to the editor [14, 16, 23, 24], and the remaining were full-text articles. There was one case series reporting six patients [26] and 15 case reports reporting one patient each. We excluded one duplicate study [23] and six studies reporting 11 patients because of insufficient data about pouch volvulus [11, 30–34].…”

Section: Resultsmentioning

confidence: 99%

“…BMI at time of presentation was reported in six patients in the case series of Landisch et al . [26] with a median value of 19.8 (range, 17.5–24.0) kg/m 2 and was not reported in the remaining patients.…”

Section: Resultsmentioning

confidence: 99%

“…In one patient, intra-operative endoscopic detorsion coupled with laparoscopic manipulation of the pouch allowed reduction of the volvulus [22]. When implemented as a sole modality of treatment, endoscopic detorsion was successful in one patient who refused surgical intervention and remained free of relapses during 3-year follow-up [26].…”

Section: Resultsmentioning

confidence: 99%

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Volvulus of the ileal pouch–anal anastomosis: a meta-narrative systematic review of frequency, diagnosis, and treatment outcomes

Jawoosh

Haffar²,

Deepak

et al. 2019

Gastroenterology Report

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Background Proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis. While rare, a pouch volvulus can occur. We aimed to determine the frequency, presentation, and management approach of pouch volvulus in patients with IPAA. Methods A systematic search of published literature was performed by a medical reference librarian on 10 August 2018 and two independent reviewers identified relevant publications, extracted data, and assessed the methodological quality based on a validated tool. A retrospective review of the Mayo Clinic electronic medical records identified one case of pouch volvulus between January 2008 and August 2018. Results The frequency of pouch volvulus from one large published study reporting long-term outcomes of IPAA was 0.18% (3/1,700). A total of 22 patients (18 ulcerative colitis) were included (median age 32 years, 73% females). Median time to volvulus after IPAA was 36 months while median interval to volvulus diagnosis from symptom onset was 24 hours. Abdominal pain was the most commonly reported symptom (76%). The diagnosis was made primarily by abdominal computed tomography (13/17 patients, 76%). Endoscopic treatment was successful in 1 of 11 patients (9%). Surgery was performed in 20 patients and pouch-pexy and pouch excision were the most frequent surgical operations. A redo IPAA was performed in five patients (25%). Conclusion Pouch volvulus is a rare but serious complication of IPAA and should be suspected even in the absence of obstruction symptoms. Endoscopic treatment often fails and surgery is effective when performed early.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Volvulus of the ileal pouch–anal anastomosis: a meta-narrative systematic review of frequency, diagnosis, and treatment outcomes

Jawoosh

Haffar²,

Deepak

et al. 2019

Gastroenterology Report

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“…The common site of a pouch volvulus is reported to be the pouch-anal anastomosis and the middle of the pouch [1][2][3][4][5][6][7][8][9]. In this case, the afferent limb of the pouch had a long-axis rotated volvulus.…”

Section: Discussionmentioning

confidence: 80%

“…Emergency surgery is needed if the intestine is necrotic or if decompression is unsuccessful due to endoscopic reduction. The common site of pouch volvulus has been reported to be the ileal pouch-anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed [1][2][3][4][5][6][7][8][9]. In order to preserve pouch and maintain quality of life (QOL), it is necessary to accurately diagnose the site of volvulus and select appropriate treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

et al. 2020

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Background Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later. Case presentation A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged. Conclusion Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.

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Complications of the Pelvic Pouch

Ashburn

Dietz

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Pouch Volvulus in Patients Having Undergone Restorative Proctocolectomy for Ulcerative Colitis: A Case Series

Cited by 20 publications

References 17 publications

Volvulus of the ileal pouch–anal anastomosis: a meta-narrative systematic review of frequency, diagnosis, and treatment outcomes

Volvulus of the ileal pouch–anal anastomosis: a meta-narrative systematic review of frequency, diagnosis, and treatment outcomes

Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

Complications of the Pelvic Pouch

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