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

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.

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

Intraoperative image of twisted S-type ileoanal pouch with proximal small bowel dilatation.

Fig. 3

Ileoanal pouch during derotation.

Fig. 4

Ileoanal pouch after complete derotation, showing the “S” shaped anastomosis.