Afferent limb syndrome after total proctocolectomy and ileal pouch-anal canal anastomosis
Abstract Background Small bowel obstruction (SBO) is a common postoperative complication of ulcerative colitis (UC). There have been a few recent reports of afferent limb syndrome (ALS) as a rare occurrence in cases of SBO. We present a case of ALS with recurrent SBO that was successfully managed su...
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Japan Surgical Society
2020-08-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-00968-w |
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| author | Keiji Matsuda Yojiro Hashiguchi Kentaro Asako Yuka Okada Kohei Ohno Mitsuo Tsukamoto Yoshihisa Fukushima Ryu Shimada Tsuyoshi Ozawa Tamuro Hayama Keijiro Nozawa Takeo Fukagawa Yuko Sasajima |
| author_facet | Keiji Matsuda Yojiro Hashiguchi Kentaro Asako Yuka Okada Kohei Ohno Mitsuo Tsukamoto Yoshihisa Fukushima Ryu Shimada Tsuyoshi Ozawa Tamuro Hayama Keijiro Nozawa Takeo Fukagawa Yuko Sasajima |
| author_sort | Keiji Matsuda |
| collection | DOAJ |
| description | Abstract Background Small bowel obstruction (SBO) is a common postoperative complication of ulcerative colitis (UC). There have been a few recent reports of afferent limb syndrome (ALS) as a rare occurrence in cases of SBO. We present a case of ALS with recurrent SBO that was successfully managed surgically. Case presentation When this male patient was 55 years old, he underwent laparoscopy-assisted anus-preserving total proctocolectomy, the creation of a J-type ileal pouch, ileal pouch-anal canal anastomosis (IPAA), and creation of ileostomy for intractable UC. Three months later, ileostomy closure was performed. The first onset of SBO was observed 5 months after ileostomy closure. SBO occurred repeatedly, and the patient was hospitalized nine times in approximately 2 years. Each SBO was improved by non-surgical treatment. A computed tomography (CT) scan revealed that the afferent limb was narrowing and twisted, and gastrografin enema confirmed narrowing at the proximal portion of the pouch inlet. Endoscopy showed a sharp angulation at the pouch inlet. We suspected ALS and decided on a surgical policy and performed pouchopexy and ileopexy to the retroperitoneum by suturing with excision of the remaining blind end of the ileum. Endoscopy 3 days after surgery showed neither twist nor stricture in the fixed ileal pouch or the afferent limb. At the time of writing, the patient remains free of SBO symptoms. Conclusion Clinicians should consider ALS when examining a patient with recurrent intermittent SBO after IPAA surgery. When ALS is suspected, the patient is indicated for surgery such as surgical pexy. |
| format | Article |
| id | doaj-art-65553db4bb5849cea092d63591d6ec05 |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-65553db4bb5849cea092d63591d6ec052025-08-20T03:56:12ZengJapan Surgical SocietySurgical Case Reports2198-77932020-08-01611710.1186/s40792-020-00968-wAfferent limb syndrome after total proctocolectomy and ileal pouch-anal canal anastomosisKeiji Matsuda0Yojiro Hashiguchi1Kentaro Asako2Yuka Okada3Kohei Ohno4Mitsuo Tsukamoto5Yoshihisa Fukushima6Ryu Shimada7Tsuyoshi Ozawa8Tamuro Hayama9Keijiro Nozawa10Takeo Fukagawa11Yuko Sasajima12Department of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Pathology, Teikyo University School of MedicineAbstract Background Small bowel obstruction (SBO) is a common postoperative complication of ulcerative colitis (UC). There have been a few recent reports of afferent limb syndrome (ALS) as a rare occurrence in cases of SBO. We present a case of ALS with recurrent SBO that was successfully managed surgically. Case presentation When this male patient was 55 years old, he underwent laparoscopy-assisted anus-preserving total proctocolectomy, the creation of a J-type ileal pouch, ileal pouch-anal canal anastomosis (IPAA), and creation of ileostomy for intractable UC. Three months later, ileostomy closure was performed. The first onset of SBO was observed 5 months after ileostomy closure. SBO occurred repeatedly, and the patient was hospitalized nine times in approximately 2 years. Each SBO was improved by non-surgical treatment. A computed tomography (CT) scan revealed that the afferent limb was narrowing and twisted, and gastrografin enema confirmed narrowing at the proximal portion of the pouch inlet. Endoscopy showed a sharp angulation at the pouch inlet. We suspected ALS and decided on a surgical policy and performed pouchopexy and ileopexy to the retroperitoneum by suturing with excision of the remaining blind end of the ileum. Endoscopy 3 days after surgery showed neither twist nor stricture in the fixed ileal pouch or the afferent limb. At the time of writing, the patient remains free of SBO symptoms. Conclusion Clinicians should consider ALS when examining a patient with recurrent intermittent SBO after IPAA surgery. When ALS is suspected, the patient is indicated for surgery such as surgical pexy.http://link.springer.com/article/10.1186/s40792-020-00968-wUlcerative colitisAfferent limb syndromeRecurrent small bowel obstructionSurgeryIleopexy |
| spellingShingle | Keiji Matsuda Yojiro Hashiguchi Kentaro Asako Yuka Okada Kohei Ohno Mitsuo Tsukamoto Yoshihisa Fukushima Ryu Shimada Tsuyoshi Ozawa Tamuro Hayama Keijiro Nozawa Takeo Fukagawa Yuko Sasajima Afferent limb syndrome after total proctocolectomy and ileal pouch-anal canal anastomosis Surgical Case Reports Ulcerative colitis Afferent limb syndrome Recurrent small bowel obstruction Surgery Ileopexy |
| title | Afferent limb syndrome after total proctocolectomy and ileal pouch-anal canal anastomosis |
| title_full | Afferent limb syndrome after total proctocolectomy and ileal pouch-anal canal anastomosis |
| title_fullStr | Afferent limb syndrome after total proctocolectomy and ileal pouch-anal canal anastomosis |
| title_full_unstemmed | Afferent limb syndrome after total proctocolectomy and ileal pouch-anal canal anastomosis |
| title_short | Afferent limb syndrome after total proctocolectomy and ileal pouch-anal canal anastomosis |
| title_sort | afferent limb syndrome after total proctocolectomy and ileal pouch anal canal anastomosis |
| topic | Ulcerative colitis Afferent limb syndrome Recurrent small bowel obstruction Surgery Ileopexy |
| url | http://link.springer.com/article/10.1186/s40792-020-00968-w |
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