Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occ...Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occur.We aimed to determine the frequency,presentation,and management approach of pouch volvulus in patients with IPAA.Methods: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 2018.Results: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 hours.Abdominal 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 symptoms.Endoscopic treatment often fails and surgery is effective when performed early.展开更多
Crohn’s disease(CD)is characterized by transmural inflammation of the gastrointestinal tract leading to inflammatory,stricturing and/or and fistulizing disease.Once a patient develops medically refractory disease,mec...Crohn’s disease(CD)is characterized by transmural inflammation of the gastrointestinal tract leading to inflammatory,stricturing and/or and fistulizing disease.Once a patient develops medically refractory disease,mechanical obstruction,fistulizing disease or perforation,surgery is indicated.Unfortunately,surgery is not curative in most cases,underscoring the importance of bowel preservation and adequate perioperative medical management.As many of the medications used to treat CD are immunosuppressive,the concern for postoperative infectious complications and anastomotic healing are particularly concerning;these concerns have to be balanced with preventing and treating residual or recurrent disease.We herein review the available literature and make recommendations regarding the preoperative,perioperative and postoperative administration of immunosuppressive medications in the current era of biological therapy for CD.Standardized algorithms for perioperative medical management would greatly assist future research for optimizing surgical outcomes and preventing disease recurrence in the future.展开更多
基金No source of funding has been declared by the authors.The guidelines of the PRISMA 2009 statement were adopted.
文摘Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occur.We aimed to determine the frequency,presentation,and management approach of pouch volvulus in patients with IPAA.Methods: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 2018.Results: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 hours.Abdominal 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 symptoms.Endoscopic treatment often fails and surgery is effective when performed early.
文摘Crohn’s disease(CD)is characterized by transmural inflammation of the gastrointestinal tract leading to inflammatory,stricturing and/or and fistulizing disease.Once a patient develops medically refractory disease,mechanical obstruction,fistulizing disease or perforation,surgery is indicated.Unfortunately,surgery is not curative in most cases,underscoring the importance of bowel preservation and adequate perioperative medical management.As many of the medications used to treat CD are immunosuppressive,the concern for postoperative infectious complications and anastomotic healing are particularly concerning;these concerns have to be balanced with preventing and treating residual or recurrent disease.We herein review the available literature and make recommendations regarding the preoperative,perioperative and postoperative administration of immunosuppressive medications in the current era of biological therapy for CD.Standardized algorithms for perioperative medical management would greatly assist future research for optimizing surgical outcomes and preventing disease recurrence in the future.
