Dual arterial blood supply D-pouch in a patient with ulcerative colitis undergoing proctocolectomy and ileal pouch-anal anastomosis

Abstract

Introduction: Pouchitis is the most common complication in Ulcerative colitis (UC) patients after restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) and ischemia may be a significant contributing factor. Tension and blood supply are the primary concerns while performing the procedure. A dual arterial blood supply technique is designed to decrease tension while ensuring sufficient blood perfusion. Patient concerns: A 61-year-old female patient with 14 years history of UC wanted to seek surgical treatment. Diagnoses: Ulcerative colitis. Interventions: After physical examination and treatment of parenteral nutrition, the patient underwent a D-pouch with dual arterial blood supply after total proctocoloectomy. Outcomes: The patient recovered well and was discharged 10 days after her procedure. Postoperatively dual arterial blood supply to the D-pouch was demonstrated by computed tomography angiography (CTA). Conclusion: D-pouch with dual arterial blood supply is feasible and safe in patients with UC undergoing RP-IPAA.

Intraoperative Techniques for Gaining Ileoanal Pouch Reach

“…36 Another case report discussed reanastomosis of the distal SMA to the inferior mesenteric artery for a difficult to reach pouch. 37 Once again, performing such techniques requires considerable technical expertise and, therefore, is generally not applicable to most ileal pouch operations.…”