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The Noble plication: new indication for a historical procedure.

D J Hochman1, S Nivatvongs, C R Selvasekar

  • 1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA. davehochman@hotmail.com

Techniques in Coloproctology
|May 19, 2007
PubMed
Summary

Small bowel volvulus is a rare complication after ileal pouch-anal anastomosis (IPAA). The modified Noble plication successfully treated this condition in a patient with an elongated mesentery, offering a non-resectional approach.

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Area of Science:

  • Gastroenterology
  • Surgical Techniques
  • Abdominal Surgery

Background:

  • Ileal pouch-anal anastomosis (IPAA) is a common surgical procedure for ulcerative colitis and familial adenomatous polyposis.
  • Complications following IPAA are well-documented, but small bowel volvulus remains a rare occurrence.
  • Management of small bowel volvulus typically involves surgical intervention to restore intestinal patency.

Observation:

  • A patient presented with small bowel volvulus secondary to an elongated mesentery following IPAA.
  • The volvulus was successfully managed using a modified Noble plication technique.
  • This approach avoided bowel resection, preserving intestinal length.

Findings:

  • The modified Noble plication effectively resolved the small bowel volvulus in this case.

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  • This historical surgical technique proved suitable for managing complex mesenteric abnormalities.
  • Non-resectional management was achieved, highlighting the technique's utility.

    • Implications:

    • The modified Noble plication can be a valuable option for treating small bowel volvulus after IPAA, particularly when non-resectional management is desired.
    • This case underscores the potential of revisiting and adapting older surgical techniques for modern clinical challenges.
    • Further studies may explore the long-term efficacy and broader applicability of this technique in similar scenarios.