A unique surgical emergency: ileosigmoid knotting

Abstract

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 knot in a patient with Down syndrome: a unique surgical emergency: a case report

“…Type III (1.5%) is the ileocecal junction which wraps around the sigmoid loop. And type IV is an indeterminate type, it is not possible to differentiate the two segments [ 6 ].…”

“…The preoperative diagnosis is difficult because of its rarity and clinico-radiological atypia, it is possible in less than 20% of cases [ 3 ]. Abdominal pain is constant, often sub-acute and progressive, associated with obstipation (98.8-100%), abdominal distension (94-100%), nausea and vomiting (77.5-100%) and rebound tenderness (36.8-100%) [ 4 , 6 , 7 ]. Abdominal X-ray may show disproportionate distension with large air-fluid levels in the sigmoid colon occupying the right side of the abdomen, with multiple air-fluid levels of the small intestine on the left side of the abdomen [ 3 ].…”

“…In the event of intestinal necrosis, resection of the small bowel, colon and node in one piece is recommended [ 3 ], with primary anastomosis if local and general conditions allow it, otherwise a left iliac colostomy or outright a double segment stoma [ 4 ]. ISK is potentially lethal condition, with a mean mortality rate of 35.5% [ 6 ]. The most common cause of death being septic shock leading to multiple organ failure.…”

A Challenging Case of Ileosigmoid Knotting in an Elderly

“…ISK is one of the uncommon but potentially life-threatening causes of bowel obstruction, in which a portion of the ileum and sigmoid colon wrap around each other, forming a closed-loop obstruction. It is commonly seen in the Africa, Asia, and the Middle East populations, with a male preponderance and mean age of presentation around 40 years [2,3]. Endemicity of the disease has also been reported in Turkey, specifically in Eastern Anatolia.…”

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

“…In this situation, devitalization of both segments occurs, and the prognosis is grave unless urgent surgical intervention is done. [3][4][5][6] Preoperative diagnosis of intestinal obstruction due to knotting is quite difficult if not impossible.…”