Skip to main content
SpringerLink
Log in

Clinical features and management of afferent limb syndrome after ileal pouch-anal anastomosis for ulcerative colitis

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222:120–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Hata K, Kazama S, Nozawa H, Kawai K, Kiyomatsu T, Tanaka J, et al. Laparoscopic surgery for ulcerative colitis: a review of the literature. Surg Today. 2015;45:933–8.

    Article  PubMed  Google Scholar 

  3. Hashimoto T, Itabashi M, Ogawa S, Hirosawa T, Bamba Y, Kaji S, et al. Treatment strategy for preventing pouchitis as a postoperative complication of ulcerative colitis: the significance of the management of cuffitis. Surg Today. 2014;44:1730–4.

    Article  PubMed  Google Scholar 

  4. Bach SP, Mortensen NJ. Ileal pouch surgery for ulcerative colitis. World J Gastroenterol. 2007;13:3288–300.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Aberg H, Pahlman L, Karlbom U. Small-bowel obstruction after restorative proctocolectomy in patients with ulcerative colitis. Int J Colorectal Dis. 2007;22:637–42.

    Article  PubMed  Google Scholar 

  6. MacLean AR, Cohen Z, MacRae HM, O’Connor BI, Mukraj D, Kennedy ED, et al. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg. 2002;235:200–6.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Marcello PW, Roberts PL, Schoetz DJ Jr, Coller JA, Murray JJ, Veidenheimer MC. Obstruction after ileal pouch-anal anastomosis: a preventable complication? Dis Colon Rectum. 1993;36:1105–11.

    Article  CAS  PubMed  Google Scholar 

  8. Read TE, Schoetz DJ Jr, Marcello PW, Roberts PL, Coller JA, Murray JJ, et al. Afferent limb obstruction complicating ileal pouch-anal anastomosis. Dis Colon Rectum. 1997;40:566–9.

    Article  CAS  PubMed  Google Scholar 

  9. Kirat HT, Kiran RP, Remzi FH, Fazio VW, Shen B. Diagnosis and management of afferent limb syndrome in patients with ileal pouch-anal anastomosis. Inflamm Bowel Dis. 2011;17:1287–90.

    Article  PubMed  Google Scholar 

  10. Shen B, Remzi FH, Lavery IC, Lashner BA, Fazio VW. A proposed classification of ileal pouch disorders and associated complications after restorative proctocolectomy. Clin Gastroenterol Hepatol. 2008;6:145–58 (quiz 24).

    Article  PubMed  Google Scholar 

  11. Ogawa H, Haneda S, Watanabe K, Suzuki H, Miura K, Ohnuma S, et al. A unique variant of afferent limb syndrome after ileal pouch-anal anastomosis: a case series and review of the literature. J Gastrointest Surg. 2012;16:1581–4.

    Article  PubMed  Google Scholar 

  12. de Zeeuw S, Ahmed Ali U, Donders RA, Hueting WE, Keus F, van Laarhoven CJ. Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. Int J Colorectal Dis. 2012;27:843–53.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Reparative Medicine, Departments of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Yoshiki Okita, Toshimitsu Araki, Mikio Kawamura, Satoru Kondo, Mikihiro Inoue, Minako Kobayashi, Yuji Toiyama, Masaki Ohi, Koji Tanaka, Yasuhiro Inoue, Keiichi Uchida, Yasuhiko Mohri & Masato Kusunoki

Authors
  1. Yoshiki Okita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshimitsu Araki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mikio Kawamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Satoru Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mikihiro Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Minako Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuji Toiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masaki Ohi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Koji Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yasuhiro Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Keiichi Uchida
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yasuhiko Mohri
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Masato Kusunoki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshiki Okita.

Ethics declarations

Conflict of interest

All of the authors declare that they have no conflicts of interest in association with this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okita, Y., Araki, T., Kawamura, M. et al. Clinical features and management of afferent limb syndrome after ileal pouch-anal anastomosis for ulcerative colitis. Surg Today 46, 1159–1165 (2016). https://doi.org/10.1007/s00595-016-1307-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-016-1307-7

Keywords

Search

Navigation