タニ　キミタカ   TANI Kimitaka   谷　公孝    所属   医学部 医学科（東京女子医科大学病院）    職種   助教
論文種別	症例報告
言語種別	英語
査読の有無	査読なし
表題	Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report.
掲載誌名	正式名：Surgical case reports 略　 称：Surg Case Rep ISSNコード：21987793/21987793
掲載区分	国外
巻・号・頁	6(1),pp.218
著者・共著者	ITABASHI Michio, BAMBA Yoshiko, AIHARA Hisako, TANI Kimitaka, NAKAGAWA Ryosuke, KOSHINO Kurodo, OHKI Takeshi, OGAWA Shinpei, INOUE Yuji, YAMAMOTO Masakazu
発行年月	2020/09
概要	BACKGROUND:Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch-anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later.CASE PRESENTATION:A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged.CONCLUSION:Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilat
DOI	10.1186/s40792-020-01007-4
PMID	32970226