González-De Leo S, Belmonte MC, Aguirre GMP, Cosme RC

Language: Spanish
References: 13
Page: 185-189
PDF size: 113.10 Kb.

ABSTRACT

Introduction: Colonic inertia is an intestinal motility disorder characterized by severe constipation that presents together with abdominal pain. This pathologic condition can be resistant to medical treatment and might need surgical correction, being a total colectomy with ileorectal anastomosis the best choice. A probable complication is the anastomotic torsion. We present a rare case of abdominal pain due to torsion of an ileorectal anastomosis after total colectomy. The case was successfully solved laparoscopically. Clinical case: 25 year-old female, with a history of a total colectomy 5 years previous to admission for colonic inertia and two subsequent episodes of abdominal pain, both solved with medical treatment. She presented with a new episode of abdominal pain and an abdominal CT and a barium enema were performed, which showed a transition zone proximal to the ileorectal anastomosis. A diagnostic laparoscopy was done, finding torsion of the ileorectal anastomosis. This anatomic abnormality was solved by closure of the mesenteric gap. Patient was discharged without complications. Conclusions: Late torsion of an ileorectal anastomosis is a rare complication that was caused apparently in this case by the lack of mesenteric gap closure, situation that hasn’t been described in literature.

REFERENCES

1. Knowles C, Scott M, Lunniss PJ. Outcome of colectomy for slow transit constipation. Ann Surg 1999; 230: 627-638.

2. Pinedo G, Zarate AJ, García E et al. Laparoscopic total colectomy for colonic inertia: surgical and functional results. Surg Endosc 2009; 23: 62-65.

3. Webster C, Dayton M. Results after colectomy for colonic inertia: a sixteen-year experience. Am J Surg 2001; 182: 639-644.

4. Platell C, Scache D, Geoff M et al. A long-term follow-up of patients undergoing colectomy for chronic idiopathic constipation. Am J Surg 1996; 66: 525-529.

5. Pfeifer J, Agachan F, Wexner S. Surgery for constipation: A review. Dis Colon Rectum 1996; 39: 444-460.

6. Wai Wong S, Lobowski DZ. Slow-transit constipation: evaluation and treatment. Am J Surg 2007; 77: 320-328.

7. Reissman P, Cohen S, Weiss E et al. Laparoscopic colorectal surgery: Ascending the learning curve. World J Surg 1996; 20: 277-282.

8. Ghosh S, Papachrysostomou M, Batool M et al. Long-term results of subtotal colectomy and evidence of non-colonic involvement in patients with idiopathic slow-transit constipation. 1996; 31: 1083-1091.

9. Sarli L, Costi R, Lusco D, Roncoroni L. Long-term results of subtotal colectomy with antiperistaltic cecoproctostomy. Surg Today 2003; 22: 823-827.

10. Frederick A. Complications of ileal pouch anal anastomosis. Seminars in Pediatric Surgery 2007; 16: 200-204.

11. Ritchie JK, Lockhart-Mummery. Non-restorative surgery in the treatment of Crohn’s disease of the large bowel. Gut 1973; 14: 263-269.

12. Milsom JW, Ludwig KA, Church JM et al. Laparoscopic total abdominal colectomy with ileorectal anastomosis for familial adenomatous polyposis. Dis Colon Rectum 1997; 40: 675-678.

13. Belmonte MC, García-Ruíz A, Chávez RJJ y cols. Colectomía total laparoscópica por inercia colónica. Reporte de un caso. Rev Mex Cir Endosc 2002; 3: 131-136.