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Volvulus of the ileal pouch-anal anastomosis:a meta-narrative systematic review of frequency,diagnosis,and treatment outcomes

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Gastroenterology Report 2019年第6期7卷 403-410,I0001页

作者： Muhammad Jawoosh Samir Haffar Parakkal Deepak Alyssa Meyers Amy L.Lightner David W.Larson Laura H.Raffals MHassan Murad Navtej Buttar Fateh Bazerbachi Division of Gastroenterology and Hepatology Dessau Municipal HospitalAuenweg 3806847 Dessau-RosslauGermany Digestive Center for Diagnosis and Treatment DamascusSyrian Arab Republic Division of Gastroenterology John T.Milliken Department of MedicineWashington University School of MedicineSt.LouisMOUSA Division of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA Department of Colorectal Surgery Cleveland ClinicClevelandOHUSA Division of Colon and Rectal Surgery Mayo ClinicRochesterMNUSA Robert D and Patricia E Kern Center for the Science of Health Care Delivery Mayo ClinicRochesterMNUSA Division of Gastroenterology Massachusetts General HospitalBostonMAUSA

Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous *** rare,a pouch volvulus can *** aimed to determine the frequency,presentation,and management approach of pouch volvulus in patients with ***:A systematic search of published literature was performed by a medical reference librarian on 10 August 2018 and two independent reviewers identified relevant publications,extracted data,and assessed the methodological quality based on a validated tool.A retrospective review of the Mayo Clinic electronic medical records identified one case of pouch volvulus between January 2008 and August ***:The frequency of pouch volvulus from one large published study reporting long-termoutcomes of IPAA was 0.18%(3/1,700).A total of 22 patients(18 ulcerative colitis)were included(median age 32 years,73%females).Median time to volvulus after IPAA was 36 months while median interval to volvulus diagnosis from symptom onset was 24 *** pain was the most commonly reported symptom(76%).The diagnosis was made primarily by abdominal computed tomography(13/17 patients,76%).Endoscopic treatment was successful in 1 of 11 patients(9%).Surgery was performed in 20 patients and pouch-pexy and pouch excision were the most frequent surgical operations.A redo IPAA was performed in five patients(25%).Conclusion:pouch volvulus is a rare but serious complication of IPAA and should be suspected even in the absence of obstruction *** treatment often fails and surgery is effective when performed early.

关键词： familial adenomatous polyposis ulcerative colitis ileal pouch–anal anastomosis pouch volvulus systematic review

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