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

Muhammad Jawoosh, Samir Haffar, Parakkal Deepak, Alyssa Meyers, Amy L. Lightner, David W. Larson, Laura H. Raffals, M. Hassan Murad, Navtej Buttar, Fateh Bazerbachi

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

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 32years, 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.

Original languageEnglish (US)
Pages (from-to)403-410
Number of pages8
JournalGastroenterology Report
Volume7
Issue number6
DOIs
StatePublished - Dec 1 2019

Keywords

  • Familial adenomatous polyposis
  • Ileal pouch-anal anastomosis
  • Pouch volvulus
  • Systematic review
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

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