EP2032 - Management Of A Proplapsed IPAA

Purpose/Background: Purpose: To discuss the surgical management of a rare complication of a prolapsed ileal pouch anal anastomosis.


Introduction: A 33-year-old man with a history of ulcerative colitis (UC) who one year prior underwent a staged total proctocolectomy with ileal pouch anal anastomosis (IPAA) presented with a full thickness, incarcerated prolapse of the pouch.

Background: The incidence of an ileoanal pouch prolapse is estimated to be 0.3%. The median interval from ileoanal pouch creation to prolapse is approximately two years. About half of the patients with full thickness prolapse are able to be managed conservatively with manual reduction of the pouch. The majority who required operative intervention underwent either ileostomy creation or pexy of the pouch with or without mesh.

Methods/Interventions: Methods/Interventions: A retrospective descriptive case report of one patient with the utilization of a diverting loop ileostomy.

Results/Outcomes: Results/Outcomes: A 33-year-old patient was taken emergently to the operative room for an exam under anesthesia in which an incarcerated full thickness prolapsed ileoanal pouch was able to be reduced. To minimize the chance of recurrence of prolapse a laparoscopic diverting loop ileostomy was performed. He did well postoperatively.

Conclusion/Discussion: Conclusion/

Discussion: Rare case complications require nuanced approaches in management. There is limited literature to guide the management of an ileoanal pouch prolapse. A diverting loop ileostomy can be a safe alternative to end ileostomy. A diverting loop ileostomy reduces pelvic pressure, effectively acts as a pexy and can preserve the ileoanal pouch for future use.

IPAA Prolapse