title: Long-axis rotational volvulus in a W ileoanal pouch: an unusual but potentially preventable problem. Report of a case.
abstract: OBJECTIVE
  This study was designed to report long-axis rotational volvulus, an unusual long-term complication of restorative proctocolectomy.
  
  
  METHODS
  A MEDLINE search using the keywords, pouch volvulus, pouch complications, ileoanal pouch volvulus, restorative proctocolectomy volvulus, restorative proctocolectomy complications, W-pouch, and early and late complications, was performed and yielded no previous reports.
  
  
  RESULTS
  We describe pouch gangrene secondary to volvulus in a W-pouch four years after restorative proctocolectomy for ulcerative colitis. Early recognition by clinical features, pouchoscopy, and soluble contrast studies are crucial if pouch salvage by pouchpexy is to be successful.
  
  
  CONCLUSIONS
  Acute necrosis of the ileoanal pouch caused by long-axis rotational volvulus is an important, but uncommon, cause of life-threatening acute abdomen after restorative proctocolectomy. Prophylactic pouchpexy at the time of pouch construction or salvage pouchpexy after early diagnosis of the at-risk pouch are important considerations to avoid loss of the pouch.
authors.affiliation: Department of Surgery, King George Hospital, Ilford, Essex, IG3 8YB, United Kingdom.
authors.forename: Md Z
authors.initials: MZ
authors.lastname: Ullah
authors.forename: Olu A
authors.initials: OA
authors.lastname: Fajobi
authors.forename: Aman M
authors.initials: AM
authors.lastname: Bhargava
mesh_terms: D000328:Adult; D039021:Colonic Pouches; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008297:Male; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*