The Noble plication: new indication for a historical procedure

Abstract

Complications following ileal pouch-anal anastomosis (IPAA) have been well-described in the literature. While rare, small bowel volvulus following IPAA has been described. We describe the successful use of the modified Noble plication in such a patient with small bowel volvulus about an elongated mesentery. This largely 'historical' technique is well-suited to manage small bowel volvulus, especially when non-resectional management is preferred.

Primary small bowel volvulus: surgical treatment dilemma

“…The Noble procedure of plicating bowel loops in a zigzag pattern, first described in 1937, is now largely only of historical significance due to unpredictable success, high incidence of mortality, prolonged ileus, wound infection and fistula formation . Modification of this technique with plication of mesentery, rather than the bowel directly, results in increased incidence of vascular injury . Baker’s tube insertion has similarly failed to become popularized due to high recurrence rate and risk of complications.…”

“…Detorsing alone carries a recurrence risk of 30%, but surgical fixation of small bowel can be technically difficult and long‐term results are not well studied. The Noble procedure of plicating bowel loops in a zigzag pattern, first described in 1937, is now largely only of historical significance due to unpredictable success, high incidence of mortality, prolonged ileus, wound infection and fistula formation . Modification of this technique with plication of mesentery, rather than the bowel directly, results in increased incidence of vascular injury .…”

Hepatocellular Cholestasis and Pruritus: Beyond Clinical Treatment

“…Due to the postoperative presentation of intussusception in our fi rst case, successfully treated with a Noble procedure, we added this plication to the original IE technique described by Hollands in our second case. Some of the complications associated with Noble plication, such as injury to the mesenteric blood supply, may be attributed to the use of interrupted, full-thickness silk sutures for bowel apposition, which can contribute to internal fi stula formation and be technically time-consuming [12] . We attempted to avoid this problem by using Polyglactin 910 (Vicryl; Ethicon Inc, NJ, USA) sutures and taking great care not to injure the mesenteric vascularization.…”

Vólvulo primario de íleon: una rara forma de obstrucción intestinal en el adulto. Reporte de caso y revisión de la literatura

“…Las placas simples de abdomen son poco específicas para el diagnóstico de VID, pero tienen una gran sensibilidad para el diagnóstico de oclusión intestinal 28 . Pueden demostrar signos de obstrucción intestinal tales como niveles hidroaéreos y asas intestinales dilatadas, así como signos de isquemia intestinal o necrosis, tales como huellas dactilares y neumatosis intestinal o, en casos extremos, gas de vena porta.…”