A technique of extending small-bowel mesentery for ileal pouch-anal anastomosis: Report of a case

One of the keys to success in proctocolectomy with ileal pouch-anal anastomosis is obtaining adequate mesenteric length to allow the pouch to reach the anorectum without tension. A multitude of techniques have been described in the literature to gain mesenteric length; however, in most cases these techniques only allow for the correction of a small deficit in the mesenteric length. We encountered a case in which the small-bowel mesentery was severely foreshortened because of a previous small-bowel volvulus just proximal to the loop ileostomy during recovery from the initial stage of his ileal pouch procedure. In this case, the deficit in length required an interposition vein graft to the superior mesenteric artery to facilitate adequate mesenteric length and allow completion of the ileal pouch-anal anastomosis. We report this technique to add another method of mesenteric lengthening to the armamentarium of surgeons performing ileal pouch-anal anastomoses. This technique should only be used as a last resort.