LAUSR

A 45-year-old woman presented with bowel obstruction. She underwent a restorative proctocolectomy with ileal-Jpouch-anal anastomosis (IPAA) 3 years previously for “ulcerative colitis-like” Crohn’s disease resistant to medical treatment. On physical examination, she had lower abdominal tenderness and acute intestinal obstruction. Abdominal computed tomography scan revealed small bowel obstruction above a volvulus of the ileal-J-pouch (Fig. 1a, b). Axial maximum intensity projection showed whirling of staple lines of the pouch (Fig. 1c). Endoscopy confirmed a complete whirling of the pouch but endoscopic detorsion failed and was complicated with pouch perforation. Surgical exploration showed pouch ischemia without necrosis. Manual detorsion of the pouch, suture of the perforation, and pexy of the pouch were done. Suture was protected with an omental flap and a diverting stoma. Opacification of the pouch and pouch endoscopy 2 months later showed normal aspect of the pouch. Outcomes of the closure of stoma were uneventful. Discussion