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Introduction: Postoperative complications, although other complications may occur, involving the respiratory tract is the most frequent one that contribute to the greatest peri operative morbidity and mortality. The occurrence of postoperative pulmonary complications varies depending on the clinical treatment setting, the kind of surgery and the definition used.

Introduction and importance: Ileosigmoid knotting (ISK), also known as double volvulus or compound volvulus is a rare cause of intestinal obstruction in which small bowel or sigmoid colon wrap around each other, causing double loop obstruction and frequently leading to bowel strangulation. This study aimed to determine the characteristics, presentation, morbidity, and mortality associated with ISK at University Hospital. Methods A retrospective medical record review of all patients operated for ISK between January 2018 and January 2023. A data collection format that was tested on five patients was used to collect data on sociodemographic characteristics, clinical presentation, preoperative investigations, preoperative stabilization, intraoperative findings, type of surgical procedure performed, and patients’ treatment outcomes. Outcomes A total of 29 patients were operated on for ISK during the study period. Of these, the medical records of 25 patients were retrieved, reviewed, and analyzed. Males were commonly affected with a male-to-female ratio of 2:1(16:9). The peak age for ISK was between 30 and 50 years. The mean age of the patients was 42.6 years (SD ± 15.9) and ranged from 20 to 70 years. Only one of the patients had comorbidity (retroviral infection). The average duration of illness was 1.6 days (SD ± 0.65), and the majority (23, 92%) presented within 48 h. Four-fifth (20, 80%) of patients are from the rural areas and the majority of them (15 (75%)) presented later than 24 h, while 3 (25%) of patients from urban settings presented within 24 h. Abdominal pain was present in all patients followed by vomiting (24, 96%), abdominal distention (22, 88%), and failure to pass feces or flatus (15, 52%). Four (16%) of the patients were in shock at the presentation. The leading abdominal findings were guarding (25, 100%), tenderness (24, 96%), rebound tenderness (21, 84%), and hyper-tympanic abdomen (11, 44%). On digital rectal examination, a stool was found in more than half (17, 68%), followed by an empty rectum (7, 28%) and blood in 2 (8%) of the patients. Preoperative imaging (plain abdominal x-ray) was done in 13 patients with symptoms of obstruction and with no features of diffuse peritonitis. Conclusion The performance of prompt, individualized surgical treatment in conjunction with the use of advanced measures of critical care to combat the disastrous consequences of multiple organ failures may contribute greatly to improving the survival rate of victims of this dreadful entity. Highlights

Background Acute appendicitis is the most common cause of acute abdominal pain, requiring emergency surgery. Symptoms and signs of acute appendicitis usually occur in the right lower quadrant. However, approximately one-third of cases have pain unexcepted location due to its various anatomical locations. Acute appendicitis is a very rare cause of left lower quadrant pain; if it occurs, situs inversus (SI) and midgut malrotation (MM) are uncommon anatomic anomalies that complicate its diagnosis and management. Clinical presentation Here we present a 23-year-old Ethiopian male patient who presented with epigastric and left paraumbilical abdominal pain, fever, and vomiting of a day duration. On examination at admission, the patient had left lower quadrant tenderness. Later, with the help of imaging studies, the patient was diagnosed with left-side acute perforated appendicitis with intestinal nonrotation, and he was operated on and discharged improved after 6 days of hospital stay. Conclusion Physicians should be aware that acute appendicitis in patients with intestinal mal-rotation may be present with left-side abdominal pain. Although it is extremely rare, acute appendicitis should always be considered in the differential diagnosis of left-side abdominal pain. An increase in awareness of this anatomical variant is essential for physicians.