Philip E George, MD, Stewart Whitney, MD, Alexander Greenstein. Icahn School of Medicine at Mount Sinai
Background: Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis has been the surgical treatment of choice for patients with Ulcerative Colitis who are medicine refractory or in those patients with dysplasia. Even with the advent of laparoscopy, complications are still present in these cases, such as Pouchitis, stricture, fistula and torsion.
Clinical Case: The video presented is of a young female with Ulcerative Colitis who had undergone a Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis who presented to our hospital with obstruction. She was treated two weeks prior to this presentation for anastomotic stricture with dilation, but now her symptoms worsened. At diagnostic laparoscopy, she was noted to have a 360 degree torsion of her J-pouch. We were able to laparoscopically detorse her J-Pouch and pexy it to the pelvic side wall using absorbable sutures in four lateral locations. The patient tolerated the procedure well and to date has not had a recurrence of her symptoms. We present this case to show our technique for detorsion, as well as an example of rare patient pathology.
Conclusion: This is one of the first cases of 360 degree J-Pouch torsion which was able to be diagnosed and managed laparoscopically. Practitioners should be suspicious of J-Pouch torsion or kinking in patients who have outflow obstruction with no relief from stricture dilatation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86304
Program Number: V055
Presentation Session: Colorectal Videos Session
Presentation Type: Video