Alabdulrahman Mohammad, Stuart Lea, Smith Ellie, O'Connell P Ronan
School of Medicine, Royal College of Surgeons in Ireland, Dublin, IRL.
Surgery, University College Dublin, Dublin, IRL.
Cureus. 2023 May 16;15(5):e39088. doi: 10.7759/cureus.39088. eCollection 2023 May.
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.
对于患有严重难治性溃疡性结肠炎（UC）且对药物治疗无反应的患者，全直肠结肠切除术和回肠储袋肛管吻合术（IPAA）是金标准治疗方法。然而，其并发症包括吻合口漏、盆腔或肛周脓肿以及诸如储袋扭转等罕见并发症。据我们所知，关于特别是复发性储袋扭转患者的病例报告很少。我们报告一例57岁难治性UC女性患者，她接受了这种治疗且最初没有并发症；15年后，她出现间歇性梗阻发作。进行了剖腹探查术；然而，未发现粘连或坏死。经过检查，确诊为储袋扭转。她随后在同年接受了4次内镜减压，最终接受了储袋固定术。扭转复发，最终决定进行袢式回肠造口术。该患者至今仍存活，永久性回肠造口术后情况良好。
