Ileo-ileal knot causing small bowel gangrene: An unusual presentation

Intestinal knot in acute Meckel’s diverticulitis

“…Typically, patients will present with acute abdomen either due to strangulation, obstruction and even as late as septic shock secondary to bowel perforation. It is postulated that the causative factors for intestinal knot are anatomical variation and dietary habit 3 5. Our patient had another incidental finding of Meckel’s diverticulum in which the possibility of Meckel’s diverticulitis and mesodiverticular obstruction causing acute abdomen needed to be considered 6 7.…”

Ileo‐ileal knot: a rare cause of acute intestinal obstruction

“…There have been only three case reports of an ileo‐ileal knot since 1988 (Table ), and all of these have been treated by bowel resection. Our patient is the only one so far, who has her knot unravelled without a bowel resection …”

“…There has been no discernible aetiology for the ileo‐ileal knot. On the other hand, causations of ileo‐sigmoidal knots have been attributed to an elongated mobile small bowel mesentery, a redundant sigmoid with a long and narrow mesentery and the intake of a single bulky meal as a dietary factor . When a semi‐liquid bulky meal progresses into the proximal jejunum, the heavier segment of the proximal jejunum falls into the lower quadrant.…”

“…Prolonged attempts to do so are unwise as ischaemic bowel becomes gangrenous rapidly and has a high risk of perforation. When an irreversible ischaemic segment is found, controlled decompression by enterotomy before untying a gangrenous knot is recommended . The necrotic ileum should be extirpated and a primary end‐to‐end anastomosis of the small bowel should be done if the distal ileum is not affected.…”

Ileo-Ileal Knot Causing Intestinal Obstruction A Case Report

“…When irreversible ischemia is present enterotomy decompression should be done first and then resection of the nonviable part of bowel is proceeded with. Manipulation of the knot with intention of untying is not recommended in ischaemic bowel, because of a high risk of perforation [8] . After resection, a primary end to end anastomosis of the small bowel should be done if the distal ileum is not affected.…”