TY - JOUR
T1 - Clinical features and management of afferent limb syndrome after ileal pouch-anal anastomosis for ulcerative colitis
AU - Okita, Yoshiki
AU - Araki, Toshimitsu
AU - Kawamura, Mikio
AU - Kondo, Satoru
AU - Inoue, Mikihiro
AU - Kobayashi, Minako
AU - Toiyama, Yuji
AU - Ohi, Masaki
AU - Tanaka, Koji
AU - Inoue, Yasuhiro
AU - Uchida, Keiichi
AU - Mohri, Yasuhiko
AU - Kusunoki, Masato
N1 - Publisher Copyright:
© 2016, Springer Japan.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Purpose: Afferent limb syndrome (ALS) is a type of small bowel obstruction (SBO) caused by obstruction of the afferent intestinal limb after ileal pouch-anal anastomosis (IPAA). The aim of this study was to reveal the clinical features and management of ALS. Methods: Of 320 patients undergoing IPAA for ulcerative colitis, we analyzed data from patients presenting with SBO. Results: Six of 19 patients with SBO were diagnosed with ALS. All patients with ALS presented with recurrent intermittent obstructive symptoms before admission, whereas 15 % of patients without ALS presented with these symptoms (P < 0.0005). Among the six patients with ALS, four patients required surgery, although they underwent transanal decompression for each episode of obstruction. The proportion of surgery was higher in the ALS group (P < 0.01). Acute angulation of the afferent limb was recognized in four cases and followed by fixation of the afferent limb. No further surgery was required in any patient following the last fixation. Conclusions: SBO after IPAA may be caused by acute angulation of the afferent limb of the ileal J-pouch. Most patients with ALS may eventually require fixation of the afferent limb due to acute angulation of the afferent limb.
AB - Purpose: Afferent limb syndrome (ALS) is a type of small bowel obstruction (SBO) caused by obstruction of the afferent intestinal limb after ileal pouch-anal anastomosis (IPAA). The aim of this study was to reveal the clinical features and management of ALS. Methods: Of 320 patients undergoing IPAA for ulcerative colitis, we analyzed data from patients presenting with SBO. Results: Six of 19 patients with SBO were diagnosed with ALS. All patients with ALS presented with recurrent intermittent obstructive symptoms before admission, whereas 15 % of patients without ALS presented with these symptoms (P < 0.0005). Among the six patients with ALS, four patients required surgery, although they underwent transanal decompression for each episode of obstruction. The proportion of surgery was higher in the ALS group (P < 0.01). Acute angulation of the afferent limb was recognized in four cases and followed by fixation of the afferent limb. No further surgery was required in any patient following the last fixation. Conclusions: SBO after IPAA may be caused by acute angulation of the afferent limb of the ileal J-pouch. Most patients with ALS may eventually require fixation of the afferent limb due to acute angulation of the afferent limb.
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U2 - 10.1007/s00595-016-1307-7
DO - 10.1007/s00595-016-1307-7
M3 - Article
C2 - 26801343
AN - SCOPUS:84955255308
SN - 0941-1291
VL - 46
SP - 1159
EP - 1165
JO - Surgery Today
JF - Surgery Today
IS - 10
ER -