Small bowel knots

Ileocecal knotting as a rare cause of small bowel obstruction: a case report

Introduction

Ileocecal knot syndrome, a rare cause of small bowel obstruction where the ileum wraps around the cecum, poses a significant challenge for preoperative diagnosis. Prompt intervention is crucial due to the risk of rapid bowel deterioration and increased mortality.

Case presentation

A 45-year-old female presented with central abdominal pain associated with vomiting, abdominal distension, and obstipation. On examination, she was ill-looking with hypotension, tachycardia with a feeble pulse, direct and rebound abdominal tenderness, and absent bowel sounds. Aggressive fluid resuscitation was done. Based on the clinical presentation and abdominal radiograph suggestive of intestinal obstruction, an emergency exploratory laparotomy was done, which showed an ileocecal knot and 130 cm of gangrenous ileum. Peritoneal lavage followed by resection of non-viable ileum with double barrel ileostomy was done.

Discussion

Ileosigmoid, appendico-ileal, ileoileal, and ileocecal knotting are the various types of intestinal knotting, with very few cases of ileocecal knotting being reported. Intestinal knotting causes severe bowel obstruction, resulting in reduced mucosal perfusion, progressive ischemia, and peritonitis, leading to high mortality. X-ray findings of multiple air-fluid levels are non-specific, and for definitive diagnosis, laparotomy is required. Assessing bowel viability before definitive surgery is essential. Despite positive outcomes, extensive resection can lead to malabsorption and ileus, with potential risk for developing short bowel syndrome.

Conclusion

Despite its rarity, the possibility of ileocecal knotting should be considered in cases of small bowel obstruction due to its potential for rapid deterioration. Prompt resuscitation followed by emergency laparotomy is necessary to prevent mortality.

Ileo-ileal knot causing acute gangrenous small bowel obstruction: a case report

BACKGROUND

Ileo-ileal knotting is a very rare cause of small bowel obstruction, and only a few reports have been published. Small bowel obstruction (SBO) is one of the most common emergency surgical conditions that require urgent evaluation and treatment and is one of the leading causes of emergency surgical admission. There are many causes of SBO that are known in general surgical practice, and these causes are different in the developing and developed worlds.

CLINICAL PRESENTATION

In this article, we present a case of acute gangrenous SBO secondary to ileo-ileal knotting in a 37-year-old Ethiopian female patient after she presented with severe abdominal cramp, vomiting, and abdominal distension of 4 hours duration. The patient was operated on intraoperatively; she had gangrenous small bowel obstruction caused by ileo-ileal knotting. Later, the patient was discharged and improved after 12 days of hospital stay.

CONCLUSION

Ileo-ileal knotting should always be considered in the differential diagnosis of acute small-bowel obstruction. The diagnostic difficulty and the need for urgent treatment of this condition to yield optimal results are discussed.

Strangulated bowel obstruction caused by an ileo-ileal knot: a rare case report

BACKGROUND

Intestinal knot formation is a condition wherein two segments of the intestine are knotted together; however, reports of small-intestinal ileo-ileal knot formation are rare.

CASE PRESENTATION

The patient was a 62-year-old Asian male with a history of endoscopic colorectal adenoma resection and a spontaneous pneumothorax. The patient had no history of a laparotomy. He consulted his local doctor with the chief complaint of abdominal pain and was admitted to our hospital with suspicion of an acute abdomen. The abdomen had muscular guarding with tenderness and rebound tenderness. Contrast-enhanced computed tomography (CT) showed torsion of the mesentery of the small intestine with poor contrast filling. The patient was referred to our department with strangulated bowel obstruction and underwent an emergency laparotomy. Intraoperative findings revealed that two segments of the ileum were wrapped around each other to form a knot, and the strangulated small bowel was necrotic. After the release of the knot, partial resection of the small intestine was performed from 220 cm distal to the ligament of Treitz to 80 cm proximal to the cecum. The patient had a good postoperative course and was discharged on the 11th postoperative day.

CONCLUSION

Ileo-ileal knots should be considered as part of the differential diagnosis when treating strangulated bowel obstruction.

A Rare Case of Ileo-Ileal Knotting: A Case Report

Small bowel obstruction due to ileo-ileal knotting is rare. Ileo-ileal knotting usually presents with clinical features of small bowel obstruction with rapid deterioration to bowel necrosis, and the management includes prompt surgical intervention. Here, we present a case of a 35-year-old patient who presented to our emergency room with severe non-radiating crampy abdominal pain for 18 hours. The patient underwent an emergency laparotomy as an intervention. Ileo-ileal knotting preoperative diagnosis is challenging due to its nonspecific presentation, the diagnosis is usually done intraoperatively, and the overall management of gangrenous ileo-ileal knotting is urgent laparotomy and en bloc resection of the gangrenous ileo-ileal knotting and anastomosis of the remaining viable bowel. If the bowel is viable, careful untying of the loops usually suffices. Ileo-ileal knotting should be considered in patients presenting with features of small bowel obstruction having rapid deterioration with signs of gangrenous bowel, and it requires urgent surgical intervention after adequate resuscitation.

A rare case report of viable ileo-ileal knotting of acute abdomen in adults

INTRODUCTION

Regardless of the cause, bowel obstruction is described as the absence of abnormal transit of intestinal contents. It may involve only the small intestine, the large intestine, or both. It might be brought on by a bodily impediment or widespread modifications to the metabolism, electrolyte balance, or neuroregulatory systems. In the field of general surgery, there are several well-known causes that can vary between developing and developed nations.

CASE PRESENTATION

In this case report, we describe a case of acute small bowel obstruction secondary to ileo-ileal knotting in 35 years old female patient with a complaint of crampy abdominal pain of 7 hour duration. She had associated frequent vomiting of ingested matter followed by bilious matter. She had also mild abdominal distention. She had history of caesarian section delivery 3 times the last time was 4 months back.

CLINICAL DISCUSSION

Ileoileal knotting is a unique and rare clinical entity in which a loop of proximal ileum wrap around the distal part of ileum. The presentation includes abdominal pain and distension, vomiting, and obstipation. The majority of cases require resection and anastomosis or exteriorization of the affected segment, and management entails a high index of suspicion and emergent investigation.

CONCLUSION

We demonstrate an instance of ileo-ileal knotting to highlight the fact that it is an unusual intraoperative finding and, given the rarity of cases, should be taken into account in the alternative diagnosis of patients exhibiting SBO signs and symptoms.

Post-operative vesicoenterocutaneous fistula with multiple intestinal knotting: A case report

Herein is a case of a 51-year-old farmer who presented to our facility with initial leakage of urine but later urine mixed with faeces from the lower abdomen after two previous abdominal surgeries. He had an open transvesical prostatectomy due to benign prostate enlargement complicated by leakage of urine from lower abdominal wall scar. A repeat surgical intervention to correct the urine leakage was followed by recurrence of urine leakage and later by leakage of feculent urine from the lower anterior abdominal wall. At our facility, he had exploratory laparotomy with manual unknotting of ileal loops, fistula tracts excision, resection, and end-to-end ileoileal anastomosis. The bladder wall was repaired with suprapubic cystostomy. Although the finding of asymptomatic multiple small bowel knotting was incidental in the index case, its timely management averted a sitting timed bomb that may lead to a diagnostic dilemma with catastrophic consequences.