J Pouch Twist at connection

Hi PB,

I was treated for a twist in my pouch 8 yrs ago. It was at the "free floating" end of the pouch though, not the anal connection. And it wasn't an easy thing for my surgeon to diagnose. All of the usual tests (barimu xray, mri, ultrasound) showed nothing wrong. It was only when I was put under general anesthestic and had a diagnostic laparoscopy done that they were able to discover what was wrong. Did Dr Remzi eyeball your insides before making the twist diagnosis?

Dr Remzi did not eyeball my insides before making the twist diagnosis. What were your exact symptoms? Did the MRI Defecography reveal anything unsual that would point out to twist? Thanks

I did not have a MRI Defecography done I've honestly never heard of it before.  I did have a very thorough scope done under general that showed nothing. When I had an abdominal x-ray during a very bad blockage it showed that my gut was obstructed but my surgical gastro couldn't find underlying the reason for it or the ones before/after it. All blockages thankfully cleared on their own and only test that revealed the twist was the final one where the surgeon stuck a camera into my abdomen. 

My symptoms were severe joint pain and pouchitis (treated) after which I had nausea and incompete emptying. I don't remember if my rectum ever felt "closed."  The twist in my pouch allowed liquid through but I had problems with blockages if I ate more than a few mouthfuls of even the blandest food. When I was experiencing a blockage, my bloodwork would show raised CRP but every thing would go back to normal once the blockage cleared. 

Regarding your emptying problem, having you tried using a step to raise your legs up?

I can barely eat solid foods without feeling blocked bloated backed up. I have to use laxatives to keep it liquid in order to be able to get some partial relief. Does fiber fruits vegatables etcc give you instant blockages? 

When I had the twist in my pouch, then yes, eating high residue food like fruit and veg was guaranteed to cause a blockage.

My surgeon warned me about laxatives when he found out I was using them to clear some of the blockages at home. He told me the most common over-the-counter ones function by causing a large influx of water into the gut, which pouches are not desgined to handle. Pouch walls are much thinner than normal colon walls so there is a higher risk of a gut tear when jpouchers use laxatives.

I should probably also mention that I did not have my pouch redone to correct the twist. My surgeon opened me up midline, removed the adhesions that was causing the twist and poured a liter of what he called anti-adhesion fluid into my abdomen.