PMC4109119_01
CT-scan showing volvulus of the pelvic pouch apparent by twisting of the posterior staple line 270 degrees just above the level of the ileoanal anastomosis (arrow).
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fig1
Repeated CT-scans at presentation and after application of the tube showed again volvulus of the pouch, which resolved after tube insertion as did the symptoms (Figure 1).
Distal ileum twisted behind the mesentery of the afferent loop (arrow).
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fig2
A loop of the distal ileum was also found to be twisted behind the mesentery of the afferent loop of the pouch as a remaining part of the volvulus (Figure 2).
The enlarged pouch twisted around the long axis of its mesentery (arrow).
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fig3
A volvulus of the pouch along its longitudinal axis was found intraoperatively as well as an accompanying volvulus of the small bowel behind the afferent loop similar to the previous laparotomy (Figure 3).
Pouchopexy by suturing the pouch to the presacral fascia on either side of the mesentery of the pouch (arrows).
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fig4
The sutures were also extended upwards to again close the open space behind the afferent loop mesentery (Figure 4).