title: A unique variant of afferent limb syndrome after ileal pouch-anal anastomosis: a case series and review of the literature.
abstract: BACKGROUND
  Afferent limb syndrome is a relatively rare cause of small bowel obstruction after restorative total proctocolectomy with ileal pouch-anal anastomosis for patients with ulcerative colitis or familial adenomatous polyposis.
  
  
  CONCLUSIONS
  This report describes three patients who developed recurrent small bowel obstruction after ileal pouch-anal anastomosis. The bowel obstruction was caused by torsion of the ileum at the inlet of the ileal J-pouch, which was thought to be a variant of afferent limb syndrome. This variant of afferent limb syndrome is characterized by a flexible afferent limb of the pelvic pouch due to the lack adhesion of the ileum in the abdominal cavity. Preoperative diagnosis required multiple series of contrast small bowel enemas. Strictureplasty and ileopexy effectively resolved the recurrent bowel obstruction caused by this variant of afferent limb syndrome.
authors.affiliation: Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aobaku, Sendai, Japan. hogawa@surg1.med.tohoku.ac.jp
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ogawa
authors.forename: Sho
authors.initials: S
authors.lastname: Haneda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Koh
authors.initials: K
authors.lastname: Miura
authors.forename: Shinobu
authors.initials: S
authors.lastname: Ohnuma
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sasaki
authors.forename: Chikashi
authors.initials: C
authors.lastname: Shibata
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis* / Q000209:etiology; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D016737:Proctocolectomy, Restorative; D012008:Recurrence; D013577:Syndrome