A rare case of obstructive ileus due to ileal pouch torsion: a case report and systematic review


  • Gavriella Zoi P. Vrakopoulou Department of General Surgery, Hippocratio Athens General Hospital, National and Kapodistrian University of Athens, Greece
  • Maria A. Matiatou Department of General Surgery, Hippocratio Athens General Hospital, National and Kapodistrian University of Athens, Greece
  • Andreas V. Larentzakis Department of General Surgery, Hippocratio Athens General Hospital, National and Kapodistrian University of Athens, Greece
  • George C. Zografos Department of General Surgery, Hippocratio Athens General Hospital, National and Kapodistrian University of Athens, Greece
  • Konstantinos G. Toutouzas Department of General Surgery, Hippocratio Athens General Hospital, National and Kapodistrian University of Athens, Greece




Ileoanal pouch torsion, IPAA complications, Ileal pouch volvulus, Pouch torsion


Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the standard surgical treatment for ulcerative colitis patients. Among others, it is important for clinicians to be aware of a rare, though urgent situation, the ileal pouch torsion. A high degree of suspicion is essential as obstruction due to pouch torsion is not likely to resolve conservatively. Delay in diagnosis and treatment can lead to pouch jeopardy and life-threatening complications. The aim of this study was to present a systematic review of the literature combined with the presentation of a case report of our department regarding this rare entity. A systematic literature review according to QUORUM guidelines was conducted in July 2019 using MEDLINE, SCOPUS, and COCHRANE databases. We included studies reporting pouch torsion after IPAA in English or German language with no restriction regarding publication time.  Outcomes after different treatment options, such as operative pouch detorsion, and/or pouchpexy, and/or pouch reconstruction, and/or end-ileostomy through laparoscopic or open procedures were evaluated. We identified 170 publications. After duplicates and irrelevant articles have been excluded, 25 publications remained for full-text review. Finally, 12 articles were included in this systematic review, concerning 14 cases. To the best of our knowledge, this is the first comprehensive systematic review on this topic to date.



Turina M, Remzi FH. The J-pouch for patients with crohn’s disease and indeterminate colitis: (when) is it an option? J Gastrointest Surg. 2014;18(7):1343-4.

Kiran RP, Fazio VW. Ileal pouch complications. in: complexities in colorectal surgery. Springer. 2013;7:259-75.

Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, et al. Ileal pouch anal anastomosis. Annals Surg. 2013;257(4):679-85.

MacLean AR, Cohen Z, MacRae HM, O’Connor BI, Mukraj D, Kennedy ED, et al. Risk of small bowel obstruction after the ileal pouch anal anastomosis. Annals Surg. 2002;235(2):200-6.

Clarke M. The QUORUM statement. Lancet. 2000;355:756-7.

Lee SY, Fok KL, Cheung HY-S, Tang C-N. Laparoscopic rectopexy for recurrent volvulus of J pouch after total proctocolectomy and ileal pouch anal anastomosis. Surgical Practice 2015;19(3):133-6

Brady JT, Steele SR. Laparoscopic detorsion of an ileal pouch and pouch pexy. Dis Colon Rectum. 2017;60(2):248.

Ullah MZ, Fajobi OA, Bhargava AM. Long-axis rotational volvulus in a w ileoanal pouch: an unusual but potentially preventable problem report of a Case. Dis Colon Rectum. 2007;50(4):540-3.

Ungaro R, Mehandru S, Allen PB, Biroulet PL, Colombel JF. Ulcerative colitis. Lancet. 2017;389(10080):1756-70.

Vavricka SR, Brun L, Ballabeni P, Pittet V, Vavricka BMP, Zeitz J, et al. Frequency and risk factors for extraintestinal manifestations in the swiss inflammatory bowel disease cohort. Am J Gastroenterol. 2010;106(1):110-9.

Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol. 2004;99(7):1371-85.

Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, et al. IIeal pouch-anal anastomoses complications and function in 1005 patients. Annals Surg. 1995;222(2):120-7.

Alexander F. Complications of ileal pouch anal anastomosis. Sem Pedia Surg. 2007;16(3):200-4.

Fazio VW, Tekkis PP, Remzi F, Lavery IC, Manilich E, Connor J, et al. Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. transactions of the Meeting of the American Surgical Association. Am Surg. 2003;121:298-310.

Sherman J, Greenstein AJ, Greenstein AJ. Ileal J Pouch complications and surgical solutions. Inflamm Bowel Dis. 2014;20(9):1678-85.

Choughari L, Sohawon S, Noordally SO. Volvulus of an ileoanal J pouch. Int J Colorectal Dis. 2010;25(8):1021-2.

17. Arima K, Watanabe M, Iwatsuki M, Ida S, Ishimoto T, Nagai Y, et al. Volvulus of an ileal pouch-rectal anastomosis after subtotal colectomy for ulcerative colitis: report of a case. Surgery Today. Springer. 2013;44:2382-2384.

Cárdenas G, Bravo R, Delgado S, Jiménez M, Martínez A, Díaz del Gobbo G, et al. Recurrent volvular herniation of the ileal pouch: a case report and literature review. International Journal of Colorectal Disease. 2015;31:749-50.

Jain A, Abbas MA, Sekhon HK, Rayhanabad JA. Volvulus of an ileal J-pouch. Inflammatory Bowel Dis. 2010;16:3-4.

Mullen MG, Cullen JM, Michaels AD, Hedrick TL, Friel CM. Ileal J-Pouch Volvulus Following Total Proctocolectomy for Ulcerative Colitis. Journal of Gastrointestinal Surgery. Springer. 2015;20:1072-3.

Myrelid P, Druvefors P, Andersson P. Recurrent Volvulus of an Ileal Pouch Requiring Repeat Pouchopexy: A Lesson Learnt. Case Reports in Surgery. 2014: 1-3.

Poggioli G, Marchetti F, Selleri S, Laureti S, Stocchi L, Gozzetti G. Redo pouches. Diseases of the Colon & Rectum. 1993;36:492-6.

Sagar PM, Dozois RR, Wolff BG, Kelly KA. Disconnection pouch revision and reconnection of the ileal pouch-anal anastomosis. British Journal of Surgery. 1996;83:1401-5.

Tyagi G, Gupta U, Verma A, Saxena D, Mittal A, Goyal A, et al. Volvulus of ileal S-pouch: A rare complication of ileal pouch anal anastomoses. Int J Surg Case Reports. 2014;5:717-9.

Warren C, O’Donnell ME, Gardiner KR, Irwin T. Successful management of ileo-anal pouch volvulus. Colorectal Dis. 2010;13:106-7.






Systematic Reviews