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Recurrent volvulus of an ileal pouch requiring repeat pouchopexy: a lesson learnt.

Myrelid P, Druvefors P, Andersson P - Case Rep Surg (2014)

Bottom Line: At follow-up after five months she was free of symptoms.Conclusion.Several rows seem to be needed.

View Article: PubMed Central - PubMed

Affiliation: Unit for Colorectal Surgery, Department of Surgery, County Council of Östergötland, 581 85 Linköping, Sweden ; Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 581 83 Linköping, Sweden.

ABSTRACT
Introduction. Restorative surgery for ulcerative colitis with ileal pouch anal anastomosis (IPAA) is frequently accompanied by complications. Volvulus of the ileal pouch is one of the most rarely reported late complications and to our knowledge no report exists on reoperative surgery for this condition. Case Report. A 58-year-old woman who previously had undergone restorative proctocolectomy due to ulcerative colitis with an IPAA presented with volvulus of the pouch. She was operated with a single row pouchopexy to the presacral fascia. Two months later she returned with a recurrent volvulus. At reoperation, the pouch was found to have become completely detached from the fascia. A new pexy was made by firmly anchoring the pouch with two rows of sutures to the presacral fascia as well as with sutures to the lateral pelvic walls. At follow-up after five months she was free of symptoms. Conclusion. This first report ever on reoperative surgery for volvulus of a pelvic pouch indicates that a single row pouchopexy might be insufficient for preventing retwisting. Several rows seem to be needed.

No MeSH data available.


Related in: MedlinePlus

The enlarged pouch twisted around the long axis of its mesentery (arrow).
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fig3: The enlarged pouch twisted around the long axis of its mesentery (arrow).

Mentions: Two months later the patient presented with identical symptoms and a CT-scan showed again volvulus of the pouch. Insertion of a tube on this occasion did not fully relieve symptoms, so this led to a decision to proceed to laparotomy. A volvulus of the pouch along its longitudinal axis was found intraoperatively as well as an accompanying volvulus of the small bowel behind the afferent loop similar to the previous laparotomy (Figure 3). No new adhesions had been formed since that laparotomy and all the sutures to the presacral fascia and retroperitoneum were completely detached except for one. The mildly ischemic pouch and small bowel were derotated and fixated once again to the sacral fascia and retroperitoneum but this time with two rows of continuous multifilament sutures (Ethibond) on either side of the pouch. The sutures were also extended upwards to again close the open space behind the afferent loop mesentery (Figure 4). Furthermore the upper corners of the pouch were sutured to the lateral walls of the pelvis. After an uncomplicated postoperative course, the patient was discharged. At follow-up ten months later she was doing well and was free of symptoms.


Recurrent volvulus of an ileal pouch requiring repeat pouchopexy: a lesson learnt.

Myrelid P, Druvefors P, Andersson P - Case Rep Surg (2014)

The enlarged pouch twisted around the long axis of its mesentery (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4109119&req=5

fig3: The enlarged pouch twisted around the long axis of its mesentery (arrow).
Mentions: Two months later the patient presented with identical symptoms and a CT-scan showed again volvulus of the pouch. Insertion of a tube on this occasion did not fully relieve symptoms, so this led to a decision to proceed to laparotomy. A volvulus of the pouch along its longitudinal axis was found intraoperatively as well as an accompanying volvulus of the small bowel behind the afferent loop similar to the previous laparotomy (Figure 3). No new adhesions had been formed since that laparotomy and all the sutures to the presacral fascia and retroperitoneum were completely detached except for one. The mildly ischemic pouch and small bowel were derotated and fixated once again to the sacral fascia and retroperitoneum but this time with two rows of continuous multifilament sutures (Ethibond) on either side of the pouch. The sutures were also extended upwards to again close the open space behind the afferent loop mesentery (Figure 4). Furthermore the upper corners of the pouch were sutured to the lateral walls of the pelvis. After an uncomplicated postoperative course, the patient was discharged. At follow-up ten months later she was doing well and was free of symptoms.

Bottom Line: At follow-up after five months she was free of symptoms.Conclusion.Several rows seem to be needed.

View Article: PubMed Central - PubMed

Affiliation: Unit for Colorectal Surgery, Department of Surgery, County Council of Östergötland, 581 85 Linköping, Sweden ; Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 581 83 Linköping, Sweden.

ABSTRACT
Introduction. Restorative surgery for ulcerative colitis with ileal pouch anal anastomosis (IPAA) is frequently accompanied by complications. Volvulus of the ileal pouch is one of the most rarely reported late complications and to our knowledge no report exists on reoperative surgery for this condition. Case Report. A 58-year-old woman who previously had undergone restorative proctocolectomy due to ulcerative colitis with an IPAA presented with volvulus of the pouch. She was operated with a single row pouchopexy to the presacral fascia. Two months later she returned with a recurrent volvulus. At reoperation, the pouch was found to have become completely detached from the fascia. A new pexy was made by firmly anchoring the pouch with two rows of sutures to the presacral fascia as well as with sutures to the lateral pelvic walls. At follow-up after five months she was free of symptoms. Conclusion. This first report ever on reoperative surgery for volvulus of a pelvic pouch indicates that a single row pouchopexy might be insufficient for preventing retwisting. Several rows seem to be needed.

No MeSH data available.


Related in: MedlinePlus