TITLE:
Long-axis rotational volvulus in an ileal J-pouch anal anastomosis: A preventable rare complication
AUTHORS:
Virgilio V. George, Alyssa Fajardo
KEYWORDS:
Ileal Pouch; Ileal Anal Anastomosis; Malrotation
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.1,
January
21,
2014
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.