The ileosigmoid knot: CT findings

Ileosigmoidal knotting: a case report and literature review of a rare cause of acute abdomen in children

Ileosigmoidal knotting (ISK) is a rare, possibly fatal cause of intestinal obstruction. ISK is a compound volvulus that is more common in Africa and Asia. ISK is mostly seen in adults, pediatric cases reported in the literature are much rarer. In this report, we present the first reported case of ISK in a pediatric patient from Nepal. An 8-year-old male child presented with symptoms of abdominal pain, vomiting, and obstipation. The abdomen was distended with generalized tenderness. Erect abdominal X-ray showed multiple air-fluid levels. Intraoperatively, gangrenous ileum loops were entangled around the sigmoid, and resection of the gangrenous ileum and sigmoid was performed. An end-to-end colo-colic anastomosis from the descending colon to the remaining sigmoid with a double-loop ileostomy was performed. Pediatric ISK is a rare fatal form of intestinal obstruction that progresses quickly to gangrene. Clinical signs and symptoms are nonspecific, making preoperative diagnosis challenging.

Ileosigmoid knotting: A case report of unique cause of acute abdomen in a Nepalese patient

Introduction and importance

Ileosigmoid knotting is a surgical emergency. Common in Asian males, it is presented with signs and symptoms of diffuse peritonitis. Aggressive resuscitation with intravenous fluids and antibiotics followed by workup enable the patient hemodynamically stable. Explorative laparotomy followed by colo-colic anastomosis and double barrel ileostomy is curative.

Case presentation

A 32-year-old-male from Nepal with a chief complain of diffuse abdominal pain for a day and signs of peritonitis presented to Emergency room. After assessing and stabilizing the patient, explorative laparotomy was performed. Ileal and sigmoid resection followed by colo-colic anastomosis and double barrel ileostomy was done. On regular follow-up, he is in his usual state of health.

Discussion

The incidence of ileosigmoid knotting is reported to be about 1.6 cases per year. It is often misdiagnosed as non-specific intestinal obstruction which confers poor prognostic value to the patient. It should be identified promptly and intervened timely.

Conclusion

Ileosigmoid knotting is a rare but dangerous differential of acute abdomen not to be missed. Early assessment and quick decision making is the key to provide excellent prognosis to the patient in need, provided adequate surgical skills are demonstrated.

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Ileosigmoid knotting is a surgical emergency.

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It is common in Asian males.

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Patient presents with signs and symptoms of diffuse peritonitis.

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Explorative laparotomy should be done.

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Ileal and sigmoid resection followed by colo-colic anastomosis with double barrel ileostomy was performed.

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.

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.

Ileosigmoid Knotting: A Rare Cause of Intestinal Obstruction and Bowel Ischemia-Case Report with Literature Review

Ileosigmoid knotting, also known as compound volvulus or double volvulus, is a rare surgical emergency causing intestinal obstruction. Principally, it is a closed-loop intestinal obstruction that involves the sigmoid and ileum. It is considered a rare cause of intestinal obstruction. Differentiation of ileosigmoid knot from simple sigmoid volvulus is important because endoscopic decompression in ileosigmoid knot might be hazardous and even fatal. Endoscopic decompression of ileosigmoid knot may lead to perforation or injury. The mortality rate of ileosigmoid knot in general may reach 48%. We present a case of a 30-year-old male patient who presented with ileosigmoid knot at our emergency room. The aim of reporting this case is to increase understanding of the condition to promote earlier diagnosis.

[A case of ileosigmoid knotting in the postpartum period]

Ileosigmoid knotting is a rare cause of intestinal obstruction. We report a case of ileosigmoid knotting occurred during the postpartum period. The diagnosis was made by means of CT scan data and confirmed intraoperatively.

Ileosigmoid knotting: an unusual cause of acute intestinal obstruction with bowel gangrene

Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction rapidly progressing to bowel gangrene. It is characterised by the wrapping of loops of ileum and sigmoid colon around each other. The condition often remains undiagnosed preoperatively; however, it can be suspected by the triad of small bowel obstruction, radiographic features suggestive of predominately large bowel obstruction and inability to deflate the intestine by a sigmoidoscope. We are reporting a case of 56-year-old man who presented with features of acute intestinal obstruction and compensated shock within 24 hours of onset of symptoms. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. In view of haemodynamic instability, end ileostomy was done after excising gangrenous segments. The patient improved and stoma closure and ileocolic anastomosis were done after 3 months in follow-up.

A unique surgical emergency: ileosigmoid knotting

Ileosigmoid knot (ISK) is a rare cause of bowel obstruction that leads to gangrenous bowel necrosis. In this condition, the ileum and sigmoid colon wrap around each other, causing a knot and strangulation of both structures. ISK is extremely rare in North America; most cases are reported in Asia and Africa. Furthermore, ISK typically presents in adults in their fourth decade or older. Here we present the rare case of an ISK in a 14-year-old male.

Ileosigmoid knotting in patients under 25 years of age: A report of two cases

INTRODUCTION

Ileosigmoid knotting is a rare cause of acute abdomen with high morbidity and mortality. Its diagnosis is infrequently made before surgery because of its varying ways of presentation and rarity.

PRESENTATION OF CASE

The first was a 21-year-old male who presented with a history of sudden generalized abdominal pain and progressive abdominal distension. He was pale and severely dehydrated. His extremities were cold and clammy. His pulse rate was 110 per minute and blood pressure was 90/50 mmHg.

The second case was 20-year-old male who presented with similar symptoms as above. He was not pale but mildly dehydrated. His pulse rate was 92 per minute and blood pressure 110/70 mmHg.

Both patients were resuscitated and had exploratory laparotomy a few hours after presentation. The first patient was found to have ileosigmoid knotting with gangrenous sigmoid colon and terminal ileum. He had Hartmann's procedure and right hemicolectomy with ileo-transverse anastomosis.

The second patient was found to have ileosigmoid knotting with viable loops of bowel. He had careful detorsion, sigmoidectomy with primary anastomosis. Both patients’ have good outcome.

DISCUSSION

This is to report two cases of ileosigmoid knotting in two male patients aged 21 and 20 years, respectively, with the hope of increasing awareness.

CONCLUSION

Ileosigmoid knotting though more common in fourth or fifth decade of life, can also occur in the 2nd decade. Early diagnosis, careful resuscitation and skilful surgical intervention will improve outcome.

Ileosigmoid knot at week 13 of pregnancy: report of a case

The ileosigmoid knot (ISK) is a rare cause of intestinal obstruction. ISK is a condition in which the ileum wraps around the base of the sigmoid colon and forms a knot, leading to high mortality with rapid progression to bowel gangrene. We herein report a rare case of ISK at week 13 of pregnancy. The ISK was diagnosed by computed tomography, and the patient underwent emergency surgery for acute abdomen. Laparotomy showed segmental gangrenous change in the sigmoid colon, which was twisted around the distal ileal loop. The gangrenous bowel was resected, and primary anastomosis was performed. To our knowledge, the present case involves the first and earliest pregnancy in which a preoperative diagnosis of ISK was made and successful treatment was performed with surgery. A radiologic approach should be undertaken for prompt diagnosis and optimal management, even in early pregnancy.

[Gastrointestinal tract volvulus: diagnosis and correlation between plain-film X-ray and multidetector computed tomography findings]

Gastrointestinal volvuli cause processes that manifest as acute abdomen. Volvuli are important not because they are common, but rather because their possible complications can be severe. All types of volvuli share a common pathophysiology, which consists of intestinal obstruction in a closed loop that results in ischemia. The clinical manifestations are nonspecific, so radiologists play a very important role in the early identification of the most common signs of torsion. These include the "bird's beak sign", the "whirlpool sign", and signs of potentially reversible or irreversible ischemia. The treatment of choice in most cases is surgery, either to correct the torsion and save the organ or to resect it if it is necrotic.

Ileosigmoid knotting: clinical appearance of 73 cases over 45.5 years

BACKGROUND

Ileosigmoid knotting (ISK) is the wrapping of the ileum around the base of the sigmoid colon. The aim of this study was to investigate the clinical outcomes of 73 patients with ISK over 45.5 years.

METHODS

The clinical records were reviewed retrospectively.

RESULTS

The age range was 7-92 years (mean 46.7 years), and 54 patients (74.0%) were male. Forty-two patients (57.5%) experienced shock. The symptom duration range was 12-120 h (mean 46.5 h). The most common clinical features were abdominal pain and tenderness in 73 patients (100.0%), obstipation in 72 patients (98.6%), distention in 70 patients (95.9%) and vomiting in 61 patients (83.6%). The rate of correct diagnosis was 4.1% when based on clinical and X-ray findings (3/73) and 100.0% when based on computed tomography or magnetic resonance imaging findings (4/4 and 2/2, respectively). The diagnosis of ISK was confirmed by surgery in all cases.

CONCLUSION

ISK is a rare disease that occurs most commonly in adult men. The disease is generally associated with shock, and the clinical features generally present as a mechanical bowel obstruction. Although X-rays may aid diagnosis, computed tomography and magnetic resonance imaging are more reliable diagnostic tools. However, the diagnosis is made at laparotomy in some cases.

The unusual volvulus : a five year retrospective analysis of nine cases

The ileosigmoid knot is a rare surgical emergency. It is an unusual type of bowel obstruction in which the ileum usually wraps around the base of the sigmoid colon and forms a pseudoknot. It is usually associated with difficult preoperative diagnosis and poor surgical outcome. To analyze the clinical presentations, operative findings, management, postoperative complications and outcome of patients with ileosigmoid knotting. A retrospective analysis of nine cases of ileosigmoid knotting over a 6-year period from July 2005 to May 2011. Ileosigmoid knotting was common in males in the fifth decade. Mean duration of symptoms prior to admission was 42.67 h. Both the ileum and the sigmoid colon were gangrenous in all the patients. Mortality was 22.22 %. The mean duration of hospital stay was 13.67 days. To conclude, ileosigmoid knotting, though a rare cause of intestinal obstruction, carries a significant risk of mortality. In our study, ileostomy along with colorectal anastomosis seemed to be a better and safer alternative than primary repair in the management of ileosigmoid knotting. Awareness of this condition among surgeons will help to reduce the morbidity and mortality associated with this unusual form of intestinal obstruction.

Ileosigmoid knot: A case report

The ileosigmoid knot is an uncommon but life-threatening cause of closed loop intestinal obstruction. Its treatment is different from a simple volvulus in that it has to be operated upon immediately. Preoperative CT scan diagnosis and prompt treatment can lead to a good outcome. Findings of simultaneous ileal and sigmoid ischemia with non-ischemic colon interposed in between should, in an appropriate clinical setting, indicate this condition. The presence of the whirl sign, medially deviated distal descending colon and cecum, and mesenteric vascular structures from the superior mesenteric vessels that converge toward the sigmoid colon on CT scan help clinch the diagnosis.

Diagnosis of colonic volvulus: findings on multidetector CT with three-dimensional reconstructions

Large bowel volvulus is a rare condition that can occur in patients who present with acute abdominal pain. Radiologists should be able to recognise its appearance on multidetector CT (MDCT) images so that the correct diagnosis can be made and catastrophic consequences can be avoided. In this article, we discuss and illustrate the MDCT and three-dimensional appearance of the various forms of large bowel volvulus. As MDCT allows the precise diagnosis of topography, mechanism and severity, this technique can provide an accurate assessment of large bowel volvulus.

The ileosigmoid knot

Ileosigmoid knot is rare yet life-threatening condition caused by acute double loop intestinal obstruction. Preoperative diagnosis is difficult and it is associated with high morbidity and mortality. We present one such patient we encountered and outline our management, and discuss the surgical options available.

Ileosigmoid knotting- a rare variant of bowel volvulus

Two patients with acute intestinal obstruction underwent exploratory laparotomy after adequate fluid resuscitation and radiological imaging. A preoperative diagnosis of sigmoid volvulus and an operative diagnosis of ileosigmoid knotting or compound volvulus were established.

Ileosigmoid knotting in a child. The first case report in a French girl

Ileosigmoid knotting occurs when the ileum wraps around the base of an elongated sigmoid colon. It is rare in developed countries, especially in children. The authors report the first case of ileosigmoid knotting in a Caucasian French girl.

Ileosigmoid knot: case report and CT findings

Ileosigmoid knot (ISK) is an unusual clinical entity of small bowel obstruction in which the ileum wraps around the base of the sigmoid colon and forms a pseudo-knot. We present the case of a 75-year-old male in whom ISK was the definitive computed tomographic finding. ISK should be considered in differential diagnosis of patients who present with ileus.

Ileosigmoid knotting

Intestinal obstruction is a common cause of emergency surgical admission. The most frequent causes are well known and may often be safely treated conservatively in the first instance. The rarer causes of intestinal obstruction require prompt diagnosis and surgery if they are not to progress rapidly to strangulation and gangrene. One such cause is the ileosigmoid knotting, which is associated with a high morbidity and mortality. With increasing travel activity and population migration this condition is now being seen outside its original geographical sites of origin. This article focuses on the aetiology, pathophysiology, clinical features, investigations and the various surgical options for the management of the ileosigmoid knotting. Studies and case reports in English literature were identified by PubMed, ISIS, Embase and CAS searches between the years 1966-2004 using the following free text keywords: ileo- sigmoid knotting, ileosigmoid knot(ting), intestinal knot(ting), compound volvulus and double volvulus. All the reference lists were reviewed to retrieve additional articles. Aggressive resuscitation, prompt surgical relief of obstruction, appropriate antibiotics, accurate intra-operative assessment of the viability of the involved loops of intestine and the use of modern postoperative intensive care will help reduce the mortality and morbidity associated with this life threatening condition.

A case of ileosigmoid knotting in a child

Ileosigmoid knotting is an unusual condition producing a strangulated ileus in which a loop of the ileum encircles the loop of the sigmoid colon and then knots on itself. It is relatively common in many parts of Africa and tends to occur in adults; however, it is rare in developed countries, especially in children. Only 3 previous cases have been reported in children, and the authors report the fourth in a 6-year-old boy, which is the first case reported in Japan.