Total proctocolectomy with creation of a pouch using a loop of small bowel followed by Ileal pouch-anal anastomosis (IPAA) is a commonly performed surgical treatment for ulcerative colitis (UC). The surgery is usually performed in 3 stages, and the ‘J-type’ of pouch is the most commonly created pouch reservoir after proctocolectomy. If the pouch is anastomosed with a twist along its longitudinal axis it may lead to stenosis at the IPAA.