Recurrent Pouch Volvulus Following Ileoanal J-Pouch Anastomosis: A Case Report

For individuals suffering from severe refractory ulcerative colitis (UC) who are unresponsive to medical treatment, a total proctocolectomy and ileal pouch-anal anastomosis (IPAA) surgery is the gold-standard treatment. However, its complications include anastomotic leaks, pelvic or perianal abscesses, and rare complications such as pouch volvulus. To our knowledge, there is a scarcity of case reports on patients with, specifically, a recurrent pouch volvulus. We present a case of a 57-year-old female with refractory UC who had undergone this treatment with no initial complications; 15 years later, she presented with intermittent bouts of obstruction. An exploratory laparotomy was performed; however, no adhesions or necrosis were found. Following investigations, pouch volvulus was confirmed. She subsequently underwent four endoscopic decompressions in the same year and ultimately received an enteropexy of the pouch. The volvulus reoccurred and, ultimately, the decision was made to perform a loop ileostomy. The patient, to date, is alive and doing well with her permanent ileostomy.

Automated summary

Total proctocolectomy and ileal pouch-anal anastomosis (IPAA) surgery is the standard treatment for severe refractory ulcerative colitis (UC) patients who do not respond to medical treatment. However, this surgery can lead to complications such as anastomotic leaks, abscesses, and rare complications like pouch volvulus. We present a case of a 57-year-old female who developed recurrent pouch volvulus 15 years after undergoing IPAA surgery. After multiple endoscopic decompressions and pouch fixation surgeries, a loop ileostomy was performed. The patient is currently alive and well with a permanent ileostomy.