Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Dis Colon Rectum. 2018 Jun;61(6):713-718. doi: 10.1097/DCR.0000000000001050.
Restorative proctocolectomy with IPAA improves quality of life in patients with medically refractory ulcerative colitis. Although bowel obstruction is common, pouch volvulus is rare and described only in case reports. Diagnosis can be challenging, resulting in delayed care and heightened morbidity.
The purpose of this study was to delineate the symptoms and successful management strategies used in patients with IPAA volvulus that result in pouch salvage.
This study was a case series.
The study was conducted at a tertiary referral center for ulcerative colitis in Milwaukee, Wisconsin.
Patients included those with volvulus of the IPAA.
Over the study period (2010-2015), 6 patients were diagnosed with IPAA volvulus. The primary outcomes were symptom manifestation, diagnostic practices, and treatment of pouch volvulus.
Six patients with ulcerative colitis were identified with pouch volvulus. The majority (n = 4) underwent a laparoscopic pouch creation and had early symptom manifestation after surgery. Complications preceding volvulus included pouch ulceration (n = 5) and pouchitis (n = 4). The most common presenting symptoms of volvulus were abdominal pain (n = 4) and obstipation (n = 4). Multiple imaging modalities were used, but volvulus was most frequently identified by CT scan. Management was primarily operative (n = 5), composed of excision of the pouch (n = 3), pouch-pexy (n = 1), and detorsion with defect closure (n = 1). Both operative and nonoperative treatment with endoscopic detorsion resulted in low morbidity and improved patient symptoms.
This single-institution study is limited by its retrospective design and small number of patients.
IPAA volvulus is a rare and challenging cause of bowel obstruction in ulcerative colitis. Heralding signs and symptoms, such as pouch ulceration and acute obstipation, should initiate a workup for a twisting pouch. Diagnosis, which is multimodal, must occur early to avert necrosis and allow for preservation of a well-functioning pouch. See Video Abstract at http://links.lww.com/DCR/A561.
采用回肠贮袋肛管吻合术（IPAA）对药物难治性溃疡性结肠炎患者进行修复，可提高其生活质量。虽然肠阻塞较为常见，但贮袋扭转十分罕见，仅见于病例报告中。由于诊断具有挑战性，可能导致治疗延迟和发病率增加。
本研究旨在描述导致贮袋得以保留的 IPAA 扭转患者的症状和成功的管理策略。
本研究为病例系列研究。
本研究在威斯康星州密尔沃基市的一家溃疡性结肠炎三级转诊中心进行。
纳入 IPAA 扭转的患者。
在研究期间（2010-2015 年），共诊断出 6 例 IPAA 扭转患者。主要结局指标为症状表现、诊断实践和贮袋扭转的治疗。
共确定 6 例溃疡性结肠炎患者患有贮袋扭转。大多数（n=4）患者接受了腹腔镜贮袋成形术，术后早期出现症状。扭转前的并发症包括贮袋溃疡（n=5）和贮袋炎（n=4）。扭转最常见的症状为腹痛（n=4）和便秘（n=4）。使用了多种影像学方法，但 CT 扫描最常发现扭转。主要治疗方法为手术（n=5），包括贮袋切除（n=3）、贮袋固定术（n=1）和扭转复位伴缺损闭合（n=1）。手术和内镜复位的非手术治疗均导致了较低的发病率和改善了患者症状。
本单中心研究受到回顾性设计和患者数量少的限制。
IPAA 扭转是溃疡性结肠炎导致肠阻塞的罕见且具挑战性的原因。贮袋溃疡和急性肠梗阻等先驱症状和体征应提示进行扭转贮袋的检查。诊断为多模式，必须早期进行，以避免坏死并保留功能良好的贮袋。观看视频摘要请访问：http://links.lww.com/DCR/A561。
