Endoscopic Management of Pouch Volvulus as a Complication of Ileal Pouch Anal Anastomosis in Patients With Ulcerative Colitis

Pouch volvulus is a rare but potentially morbid complication after total proctocolectomy with ileal pouch anal anastomosis, typically managed surgically. Evidence for definitive endoscopic therapy is limited. We report 2 patients with ulcerative colitis who developed pouch volvulus after ileal pouch anal anastomosis and were poor surgical candidates due to medical complexity. Both underwent successful endoscopic detorsion; 1 required adjunctive endoscopic decompression with temporary tube placement. Symptoms resolved without ischemia, and no recurrence occurred through 6 months of follow-up. These cases suggest endoscopic detorsion can be a safe, diagnostic, and definitive management option for complex patients with viable pouch mucosa.