case_images: PMC4109119_01
case_images: 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).
case_images: CRIS2014-807640.001.jpg
case_images: PMC4109119_01_CRIS2014-807640.001.jpg
case_images: fig1
case_images: 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).
case_images: Distal ileum twisted behind the mesentery of the afferent loop (arrow).
case_images: CRIS2014-807640.002.jpg
case_images: PMC4109119_01_CRIS2014-807640.002.jpg
case_images: fig2
case_images: 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).
case_images: The enlarged pouch twisted around the long axis of its mesentery (arrow).
case_images: CRIS2014-807640.003.jpg
case_images: PMC4109119_01_CRIS2014-807640.003.jpg
case_images: fig3
case_images: 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).
case_images: Pouchopexy by suturing the pouch to the presacral fascia on either side of the mesentery of the pouch (arrows).
case_images: CRIS2014-807640.004.jpg
case_images: PMC4109119_01_CRIS2014-807640.004.jpg
case_images: fig4
case_images: The sutures were also extended upwards to again close the open space behind the afferent loop mesentery (Figure 4).