Objectives:We described the technique of utilizing the marginal vascular arcade (MVA) of the right colon as blood supply to the ileal pouch in restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA) after high ligation of the superior mesenteric artery (SMA). The results of having performed this surgical procedure on patients with familial adenomatous polyposis (FAP) and (UC) are presented.Methods:The method of RPC with IPAA using the above-mentioned mesentric lengthening technique is described.Results:There were 5 patients, all were male with a mean age of 37 years. Four (80%) had FAP, one (20%) had UC. Two (40%) of the patients had a family history of polyposis or colon cancer. Three (60%) had stapled anastomosis; the remaining (40%) were hand-sewn. All patients had a protecting stoma. The mean total hospital length of stay (LOS) was 21 days with a mean postoperative LOS of 8 days. Two morbidities were reported in a single patient an anastomotic leak and an ileoanal anstomotic structure. There were no mortalities. There were no intra-operative abandonments of the anal restoration.Conclusion:The technique of utilizing the MVA of the right colon provides a safe, reliable and durable alternate blood supply to the ileal pouch in patients undergoing RPC with IPAA.Key words: restorative proctocolectomy, familial adenomatous polyposis, ulcerative colitis
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A rare case of right sided diaphragmatic hernia, in a 49 year-old male with a history of penetrating right chest trauma thirty years prior to consultation, is reported. The salient features of the successful management of this patient, presenting with signs and symptoms of complete intestinal obstruction, is described. The natural history of diaphragmatic hernias is reviewed.