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Long-axis rotational volvulus in an ileal J-pouch anal anastomosis: A preventable rare complication

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DOI: 10.4236/crcm.2014.31007    2,912 Downloads   4,108 Views  

ABSTRACT

Puropose: This study was designed to report a very rare long-term complication of ileal-Jpouch anal anastomosis: An 180 degree longaxial rotational volvulus causing J pouch obstruction. Methods: An Ovid and Medline search using the following keywords was performed: J pouch ileoanal anastomosis, J-pouch ileoanal anastomosis complications, J-pouch volvulus, J-pouch complications, restorative proctocolectomy complications, and restorative proctocolectomy volvulus. One J-pouch ileoanal anastomosis 180° volvulus report was found [1]. Result: We describe a long-axis 180° rotational volvulus complication of a J-pouch ileoanal anastomosis. The J pouch was performed three years prior after the laparoscopic total proctocolectomy for chronic ulcerative colitis. Pouch excision and new ileoanal J-pouch surgery were then performed along with pexy using alloderm mesh placement with excellent outcomes. Conclusion: Long-axis 180° rotational volvulus is a rare complication of a J-pouch ileoanal anastomosis. Pouch dysfunction after a long-axis rotational volvulus is an uncommon cause of acute abdomen. Lack of adhesions and pouch size are risk factors for the pouch torsion. Prompt diagnosis and treatment are essential for the pouch salvage. Simple abdominal x-ray, barium enema and CT scan represent important tools for diagnosis. Salvage surgery should be performed even if detorsion and decompression of the affected bowel are achieved. Surgery has excellent outcomes if performed after the prompt diagnosis. Pouch pexy should be done to prevent recurrent volvulus.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

George, V. and Fajardo, A. (2014) Long-axis rotational volvulus in an ileal J-pouch anal anastomosis: A preventable rare complication. Case Reports in Clinical Medicine, 3, 28-31. doi: 10.4236/crcm.2014.31007.

References

[1] Swarnkar, K. Hopper, N. Ryder, J. Feroz, A. and Stephenson, B.M. (2004) 3 years follow-up of a twisted ileoanal pouch. Colorectal Disease, 6, 133-134.
http://dx.doi.org/10.1111/j.1463-1318.2004.00575.x
[2] Swarnkar, K., Hopper, N., Ryder, J., Feroz, A. and Stephenson, B. (2004) 3 years follow-up of a twisted ileoanal pouch. Colorectal Disease, 6, 133-134.
http://dx.doi.org/10.1111/j.1463-1318.2004.00575.x
[3] Cohen, R., Yamashita, B. and Diamond, R. (2006) Quality of life after proctocolectomy with ileoanal anastomosis for patients with ulcerative colitis. Journal of Clinical Gastroenterology, 40, 669-677.
http://dx.doi.org/10.1097/00004836-200609000-00002
[4] National Digestive Disease Information Clearinghouse (NDDIC) (2007) Digestive disease statistics.
http://digestive.niddk.nih.gov/statistics/.htm/
[5] Loftus, Jr., E.V. (2004) Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence and environmental influence. Gastroenterology, 126, 1504-1517.
[6] Shen, B., Fazio, V.W., Remzi, F.H. and Lashner, B.A. (2005) Clinical approach to diseases of ileal pouch-anal anastomosis. American Journal of Gastroenterology, 100, 2796-807. http://dx.doi.org/10.1111/j.1572-0241.2005.00278.x
[7] Parks, A.G. and Nicholls, R.J. (1978) Proctocolectomy without ileostomy for ulcerative colitis. British Medical Journal, 2, 85-88.
http://dx.doi.org/10.1136/bmj.2.6130.85
[8] Larson, D., Dozois, E., Piotrowicz, K.R.N., Cima, R., Wolff, B. and Young-Fadok, T. (2005) Laparoscopic-assisted vs. open ileal pouch anal anastomosis: Functional outcomes in a case-matched series. Diseases of the Colon & Rectum, 48, 1845-1850.
http://dx.doi.org/10.1007/s10350-005-0143-4
[9] Maartense, S., Dunker, M., Slors, J.F.. Cuesta, M., Gouma, D., Van Deventer, S., Van Bodegraven, A. and Bemeldan, W. (2004) Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: A randomized trial. Annals of Surgery, 540, 984-991.
[10] Crema, M.D., Richarme, D., Azizi, L., Hoeffel, C.C., Tubiana, J.M. and Arrive, L. (2006) Pouchography, CT, and MRI features of ileal J pouch-anal anastomosis. American Journal of Roentgenology, 187, W594-W603.
http://dx.doi.org/10.2214/AJR.05.0870
[11] Hagen, G., Kolmannskog, F., Aasen, S., Bakka, A., Lotveit, T. and Mathisen, O. (1999) Radiology of Ileal J anal pouch anastomosis. Acta Radiologica, 64, 563-568.
http://dx.doi.org/10.3109/02841859309175408
[12] Dolinsky, D., Levine, M.S., Rubesin, SE., Laufer, I. and Rombeau, J.L. (2007) Utility of contrast enema for detecting anastomotic strictures after total proctocolectomy and ileal pouch-anal anastomosis. American Journal of Roentgenology, 189, 25-29.
http://dx.doi.org/10.2214/AJR.06.1382
[13] Catalano, O. (1996) Small bowel volvulus following ileal pouch-anal anastomosis: CT demonstration. European Journal of Radiology, 23, 115-117.
http://dx.doi.org/10.1016/0720-048X(96)01065-0
[14] Tulchinsky, H., Cohen, CR. and Nicholls, R.J. (2003) Salvage surgery after restorative proctocolectomy. British Journal of Surgery, 90, 909-921.
http://dx.doi.org/10.1002/bjs.4278
[15] Korsgen, S., Nikiteas, N., Ogunbiyi, O. and Keighley, A. (1996) Results from pouch salvage. British Journal of Surgery, 83, 372-374.
http://dx.doi.org/10.1002/bjs.1800830325
[16] Reed, T., Schoetz, D., Marcello, P., Roberts, P., Coller, J., Murray, J. and Rusin, L. (1997) Afferent limb obstruction complicating ileal pouch anal anastomosis. Diseases of Colon & Rectum, 40, 566-569.
[17] Ullah, Z., Fajobi, O. and Bhargava, A. (2007) Long-axis rotational volvulus in a W ileoanal pouch: An unusual but potentially preventable problem. Diseases of the Colon & Rectum, 50, 540-543.
http://dx.doi.org/10.1007/s10350-006-0825-6
[18] Turan, M., Sen, M., Karadayi, K., Koyuncu, A., Topcu, O., Yildirir, C. and Duman, M. (2004) Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process. Revista Espanola de Enfermedades Digestivas, 96, 32-35.
http://dx.doi.org/10.4321/S1130-01082004000100005
[19] Sagar, P.M., Dozois, R.R., Wolff, B.G. and Kelly, K.A. (1996) Disconnection, pouch revision and reconnection of the ileal pouch-anal anastomosis. British Journal of Surgery, 83, 1401-1405.
http://dx.doi.org/10.1002/bjs.1800831025
[20] Dayton, M. (2000) Redo ileal pouch-anal anastomosis for malfunctioning pouches: Acceptable alternative to permanent ileostomy? American Journal of Surgery, 180, 561-565.

  
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