Volvulus of the ileal pouch–anal anastomosis: a meta-narrative systematic review of frequency, diagnosis, and treatment outcomes

Abstract

Background Proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis. While rare, a pouch volvulus can occur. We aimed to determine the frequency, presentation, and management approach of pouch volvulus in patients with IPAA. Methods A systematic search of published literature was performed by a medical reference librarian on 10 August 2018 and two independent reviewers identified relevant publications, extracted data, and assessed the methodological quality based on a validated tool. A retrospective review of the Mayo Clinic electronic medical records identified one case of pouch volvulus between January 2008 and August 2018. Results The frequency of pouch volvulus from one large published study reporting long-term outcomes of IPAA was 0.18% (3/1,700). A total of 22 patients (18 ulcerative colitis) were included (median age 32 years, 73% females). Median time to volvulus after IPAA was 36 months while median interval to volvulus diagnosis from symptom onset was 24 hours. Abdominal pain was the most commonly reported symptom (76%). The diagnosis was made primarily by abdominal computed tomography (13/17 patients, 76%). Endoscopic treatment was successful in 1 of 11 patients (9%). Surgery was performed in 20 patients and pouch-pexy and pouch excision were the most frequent surgical operations. A redo IPAA was performed in five patients (25%). Conclusion Pouch volvulus is a rare but serious complication of IPAA and should be suspected even in the absence of obstruction symptoms. Endoscopic treatment often fails and surgery is effective when performed early.

Normal liver stiffness and influencing factors in healthy children: An individual participant data meta‐analysis

“…14 We kept items focused on the representativeness of the cases and ascertainment of outcome and removed items that related to the selection of the controls and comparability. This tool has been applied in many previous publications, 3,[15][16][17][18] with good consistency among reviewers. The assessment of methodologic quality for the 10 included cohorts and the overall risk of bias for these cohorts are found in Supplemental Information.…”

Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

“…Repeated symptoms were also observed in this case, and he was referred to our hospital for the purpose of surgery. Enema and MDCT are useful in the diagnosis of a volvulus, and corkscrew and whirl signs are typical findings [1,2]. The previous reports showed that the risk factors of pouch volvulus were minimally invasive technique, few adhesions in the pelvis, female sex, low BMI, the oral intestinal tract reaches the pelvis with sufficient margins and an anterior positioning of the pouch mesentery [2,5].…”

“…The common site of a pouch volvulus is reported to be the pouch–anal anastomosis and the middle of the pouch [ 1 – 9 ]. In this case, the afferent limb of the pouch had a long-axis rotated volvulus.…”

“…Pouch volvulus after proctocolectomy for ulcerative colitis (UC) is a very rare postoperative complication, and the incidence is reported to be 0.18% (3/1700 cases) [1]. Emergency surgery is needed if the intestine is necrotic or if decompression is unsuccessful due to endoscopic reduction.…”

“…Emergency surgery is needed if the intestine is necrotic or if decompression is unsuccessful due to endoscopic reduction. The common site of pouch volvulus has been reported to be the ileal pouch-anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed [1][2][3][4][5][6][7][8][9]. In order to preserve pouch and maintain quality of life (QOL), it is necessary to accurately diagnose the site of volvulus and select appropriate treatment strategies.…”