Faculty Collaboration Database

Pouch Volvulus in Patients Having Undergone Restorative Proctocolectomy for Ulcerative Colitis: A Case Series. Dis Colon Rectum 2018 Jun;61(6):713-718

Date

04/18/2018

Pubmed ID

29664798

DOI

10.1097/DCR.0000000000001050

Scopus ID

2-s2.0-85047745257 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

BACKGROUND: Restorative proctocolectomy with IPAA improves quality of life in patients with medically refractory ulcerative colitis. Although bowel obstruction is common, pouch volvulus is rare and described only in case reports. Diagnosis can be challenging, resulting in delayed care and heightened morbidity.

OBJECTIVE: The purpose of this study was to delineate the symptoms and successful management strategies used in patients with IPAA volvulus that result in pouch salvage.

DESIGN: This study was a case series.

SETTINGS: The study was conducted at a tertiary referral center for ulcerative colitis in Milwaukee, Wisconsin.

PATIENTS: Patients included those with volvulus of the IPAA.

MAIN OUTCOME MEASURES: Over the study period (2010-2015), 6 patients were diagnosed with IPAA volvulus. The primary outcomes were symptom manifestation, diagnostic practices, and treatment of pouch volvulus.

RESULTS: Six patients with ulcerative colitis were identified with pouch volvulus. The majority (n = 4) underwent a laparoscopic pouch creation and had early symptom manifestation after surgery. Complications preceding volvulus included pouch ulceration (n = 5) and pouchitis (n = 4). The most common presenting symptoms of volvulus were abdominal pain (n = 4) and obstipation (n = 4). Multiple imaging modalities were used, but volvulus was most frequently identified by CT scan. Management was primarily operative (n = 5), composed of excision of the pouch (n = 3), pouch-pexy (n = 1), and detorsion with defect closure (n = 1). Both operative and nonoperative treatment with endoscopic detorsion resulted in low morbidity and improved patient symptoms.

LIMITATIONS: This single-institution study is limited by its retrospective design and small number of patients.

CONCLUSIONS: IPAA volvulus is a rare and challenging cause of bowel obstruction in ulcerative colitis. Heralding signs and symptoms, such as pouch ulceration and acute obstipation, should initiate a workup for a twisting pouch. Diagnosis, which is multimodal, must occur early to avert necrosis and allow for preservation of a well-functioning pouch. See Video Abstract at http://links.lww.com/DCR/A561.

Author List

Landisch RM, Knechtges PM, Otterson MF, Ludwig KA, Ridolfi TJ

Authors

Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Mary F. Otterson MD Professor in the Surgery department at Medical College of Wisconsin
Timothy J. Ridolfi MD, MS, FACS Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenomatous Polyposis Coli
Adult
Anastomosis, Surgical
Colitis, Ulcerative
Colonic Pouches
Female
Humans
Intestinal Volvulus
Laparoscopy
Male
Middle Aged
Pouchitis
Proctocolectomy, Restorative
Quality of Life
Retrospective Studies
Tomography, X-Ray Computed
Wisconsin
Young Adult