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01-09-2019 | Proctocolectomy | The Last Image
Pouch–uterine volvulus: a variant of floppy pouch syndrome?
Published in: Techniques in Coloproctology | Issue 9/2019
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A young female with prior restorative proctocolectomy presented with a small bowel obstruction. Outside imaging 3 days prior for abdominal pain was normal (Fig. 1). A repeat scan demonstrated a distal obstruction due to a uterine volvulus behind the pouch (Figs. 2, 3). On exploration, there were no pelvic adhesions and there was distal ischemia of the pouch. The patient had uterine detorsion and pexy, and handsewn revision of the ileoanal pouch.
Fig. 1
Sagittal image of the pelvis that demonstrates normal anatomy and normal appearing, contrast-filled pouch 3 days prior to presentation
Fig. 2
Sagittal image demonstrates dilated ileal pouch with hourglass appearance and a newly retroflexed uterus
Fig. 3
Narrowing of the pouch due to a twisted uterus demonstrated on coronal imaging
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