A unique surgical emergency: ileosigmoid knotting

Sigmoid Volvulus and Ileosigmoid Knotting: An Update

Sigmoid volvulus and ileosigmoid knotting are uncommon intestinal obstructions, which generally affect adult males. The etiology is multifactorial. Volvulus triad including abdominal pain/tenderness, distention, and obsti pation/constipation is the common clinical presentation. Although x-ray radiography helps with diagnosis, the current diagnostic procedure is computed tomography or magnetic resonance imaging in addition to flexible endoscopy in sigmoid volvulus. Endoscopic decompression is the primary treatment except for the presence of bowel gangrene and peritonitis in sigmoid volvulus, while such conditions and also ileosigmoid knotting require emergency surgery. The prognosis is relatively poor under these adverse circumstances and in ileosigmoid knotting.

Ileosigmoid Knotting: A Case Series

Ileosigmoid knotting is a rare case of intestinal obstruction that later leads to bowel necrosis. This is more common in males than females and seen more in areas with increased rates of sigmoid volvulus. The main clinical presentations are abdominal distention, abdominal pain and tenderness, vomiting, and obstipation. Definitive diagnosis is challenging due to its rarity and overlapping symptoms with other more common abdominal conditions. Delay in diagnosis and management can lead to peritonitis, necrosis of the bowel, sepsis, and eventually septic shock. Surgeons should consider ileosigmoid knotting in cases of acute abdomen, as it requires fast decision-making and intervention for a good prognosis. We present two cases of ileosigmoid knotting presenting with acute abdomen requiring emergent laparotomy with resection of necrotic bowel.

Ileosigmoid knot in a patient with Down syndrome: a unique surgical emergency

The ileosigmoid knot (ISK) or double ileosigmoid volvulus is a wrapping of the small intestine around the base of the sigmoid colon. We report an unusual case in the digestive surgery department of the Ibn Tofail Hospital of CHU Mohammed VI Marrakech of a 28-year-old man with Down's syndrome who presented with symptoms and signs of intestinal obstruction. Abdominal CT scan revealed a whirl sing and significant distension of the sigmoid loop. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. The surgical procedure was a necrotic digestive segments resection, with a double-barrelled ileostomy and a Hartmann procedure. One month afterwards, the patient was operated on to reestablish of the continuity. Through this observation and a review of the literature we define the diagnostic, therapeutic and prognosis aspects of this rare clinical entity.

Ileocecal knotting in a young man: A very rare and unique cause of intestinal obstruction

Ileocecal knitting should be considered as a differential diagnosis of small intestinal obstruction. Aggressive resuscitation and early surgery will be life-saving. One should anticipate finding extensive bowel gangrene which requires aggressive resection.

A Challenging Case of Ileosigmoid Knotting in an Elderly

Ileosigmoid knotting (ISK) is one of the rare causes of acute intestinal obstruction, which has a rapid course for forming gangrene. ISK is considered a variant of sigmoid volvulus, which otherwise is called compound volvulus. The difficulty in ISK diagnoses is owing to its rarity, uncommon presentation, and non-specific radiological findings. The physiological status of the patient and intraoperative findings are the key factors in deciding the operative procedure of choice. Herein the author describes a rare case of ISK in a 70-year-old man with gangrenous ileum and sigmoid colon, which were treated successfully with resection and double stoma.