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. 2014;5(10):717-9.
doi: 10.1016/j.ijscr.2014.07.005. Epub 2014 Aug 23.

Volvulus of ileal S-pouch: A rare complication of ileal pouch anal anastomoses

Gaurav Tyagi  1 , Utsav Gupta  2 , Ankit Verma  3 , Dhananjay Saxena  4 , Atul Mittal  5 , Amit Goyal  6 , Jeevan Kankaria  7 , R K Jenaw  8
Affiliations

Volvulus of ileal S-pouch: A rare complication of ileal pouch anal anastomoses

Gaurav Tyagi et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Ileal pouch anal anastomosis (IPAA) after total proctocolectomy is a frequently performed surgery for medically refractory ulcerative colitis (UC). Volvulus of the ileal pouch as a complication of IPAA is extremely rare. We present a case of volvulus of S-type ileal pouch.

Presentation of case: A 28 year old male, with history of total proctocolectomy with IPAA for severe UC in 2009 presented with signs of bowel obstruction. Emergency laparotomy was done and a volvulus of the S-type ileal pouch was derotated and pouchpexy done.

Discussion: The IPAA has a wide spectrum of complications, with obstruction of proximal small bowel occurring frequently. Volvulus of the ileal pouch is extremely rare with only 3 reported cases. Early diagnosis and intervention is important to salvage the pouch. Computed tomography (CT) may aid the diagnosis in stable patients.

Conclusion: The diagnosis of ileal pouch volvulus although rare, should be kept in mind when dealing with patients complaining of recurrent obstruction following IPAA.

Keywords: IPAA; Ileal S-pouch; Ileal pouch volvulus; Pouchpexy; Volvulus.

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Figures

Fig. 1
Fig. 1
Abdominal radiograph showing multiple air fluid levels and a large dilated small bowel loop reaching up to the left dome of diaphragm.
Fig. 2
Fig. 2
Intraoperative image of twisted S-type ileoanal pouch with proximal small bowel dilatation.
Fig. 3
Fig. 3
Ileoanal pouch during derotation.
Fig. 4
Fig. 4
Ileoanal pouch after complete derotation, showing the “S” shaped anastomosis.
See this image and copyright information in PMC

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