PMC7796826_01
Postevacuation film showing a twist of the pull-through demonstrated by a shift in the mesenteric border of the pull through segment.
10-1055-s-0040-1717128-i200525cr-1.jpg
PMC7796826_01_10-1055-s-0040-1717128-i200525cr-1.jpg
FI200525cr-1
 Our review of the post pull-through contrast enema ( Fig. 1 ) came to a different conclusion. We felt the study showed a 180-degree twist in the distal pull-through ( Fig. 1 ).
Contrast enema with absence of haustrations in the distal segment denoted by "}." The arrow denotes widening of the presacral space.
10-1055-s-0040-1717128-i200525cr-2.jpg
PMC7796826_01_10-1055-s-0040-1717128-i200525cr-2.jpg
FI200525cr-2
Since this patient had a previous Soave pull-through, it was also important to note the presence of presacral space widening ( Fig. 2 ), which could be indicative of a Soave cuff; however, this was not evident on the physical exam.
Twist in the pull-through segment with the mesentery noted on the anterior aspect (the patient is in prone position).
10-1055-s-0040-1717128-i200525cr-3.jpg
PMC7796826_01_10-1055-s-0040-1717128-i200525cr-3.jpg
FI200525cr-3
We performed a Swenson type redo transanal only pull-through and upon transanal mobilization the distal pull-through was noted to have a 180-degree twist, with the mesentery on the anterior side when it should have been either medial or posterior ( Fig. 3 ).