Twisting of distal ileum around end ileostomy: is it a specific complication after laparoscopic subtotal colectomy?

Ulcerative colitis affects 1 in 1000 people in Western cultures. In acute colitis, up to 40% of cases require surgical intervention. In suitable patients laparoscopic subtotal colectomy has become the standard of care. This case series demonstrates the hitherto unreported complication of twisting of an end ileostomy after laparoscopic subtotal colectomy. Each of the cases shared a young age and a slow postoperative recovery. The fact that the ileostomies remained intact after an open approach indicates that the laparoscopic approach (and its limitations) must be at least partly responsible for the initial morbidity in these cases. Limited literature means we can only speculate as to the reason for twisted ileostomy. Apart from the above stated reason, it may be that the minimally invasive approach causes fewer intraperitoneal adhesions than an open approach due to reduced bowel handling, allowing the small bowel to move more freely within the abdomen causing twisting. Numerous studies have applauded the use of minimally invasive colonic resection in cases of inflammatory bowel disease; however, great care must be taken to avoid this specific complication occurring when using a laparoscopic approach.