Ileal J-Pouch Volvulus Following Total Proctocolectomy for Ulcerative Colitis

Area of Science:

• Gastroenterology and Surgical Innovation
• Inflammatory Bowel Disease Management
• Abdominal Surgery

Background:

• Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical option for ulcerative colitis, aiming to restore fecal continence.
• Despite its benefits, IPAA is linked to significant post-operative morbidity, including pouchitis, anastomotic leaks, and bowel obstructions.

Observation:

• Ileal pouch volvulus, a rare complication, can cause obstruction after IPAA.
• This case highlights a unique instance where ileal pouch volvulus resulted from an internal hernia.

Findings:

• Early identification of volvulus through radiographic and endoscopic imaging was crucial.
• Prompt diagnosis facilitated timely surgical intervention, leading to successful pouch salvage.

Implications:

• This case underscores the importance of considering rare complications like ileal pouch volvulus in patients with obstructive symptoms post-IPAA.
• Early diagnostic imaging and endoscopic evaluation are key for managing such rare surgical emergencies and preserving pouch function.
• Awareness of internal hernia as a cause of ileal pouch volvulus can guide surgical planning and management strategies.