The case of the inside-out J-pouch: an incarcerated, prolapsed ileal pouch

Excerpt

A middle-aged male presented with a 24-h history of an ileal pouch prolapse, 15 years after restorative proctocolectomy for ulcerative colitis. He reported chronic, severe defecatory dysfunction. Examination revealed an incarcerated complete pouch prolapse, with significant edema and venous congestion but no frank necrosis (Figs. 1, 2). Following manual reduction, a bolster was placed in his now severely patulous anus (> 8 cm diameter, Fig. 3). After 24 h, the patient underwent a laparoscopic loop ileostomy with the distal limb secured under moderate tension to pexy the prolapse. At follow-up 6 weeks later, there was no recurrence and both anorectal ultrasound and manometry were normal.

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