Ileosigmoid Knotting Causing Double Lumen Acute Intestinal Obstruction and Gangrene: Review and A Case Report

Abstract

Ileosigmoid Knotting is a rare cause of intestinal obstruction. It is also called as compound volvulus or double volvulus. It is caused by the wrapping of the ileum around the sigmoid colon and its mesentery or vice-versa. It is a rapidly progressive condition, leads to acute intestinal obstruction and gangrene in ileum as well as in the sigmoid colon. Early diagnosis and intervention is the key to a better outcome. Due to the rarity and unfamiliarity of this entity, diagnosis is usually made intraoperatively. Surgical removal of the gangrenous segment with either stoma formation or anastomosis is the only hope.An additional systemic search of the literature was done in PubMed, MEDLINE, ISIS, Embase, and CAS searches with the following free text keywords: ileosigmoid knotting, intestinal knotting, compound volvulus and double volvulus in English literature. Around 64 studies were identified, out of which 38 studies were selected for this article after the removal of duplicates and unrelated articles. These case series and reports were reviewed for aetiopathogenesis, presentation, diagnostic modalities, surgical interventions, and outcome.Along with this review article, there was a case report of ileosigmoid knotting in a 38-year-old male patient that presented in the surgical Emergency Department; with complaints of generalised pain and distention of abdomen for two days. Also, he had complained of not passing flatus and motion for two days. On examination, patient had generalised tenderness and bowel sounds were absent. X-ray abdomen showed dilated small and large bowel with multiple air-fluid levels. After resuscitation, an emergency exploratory laparotomy was done, and the diagnosis of ileosigmoid knotting with gangrene of both ileum and sigmoid colon was made intraoperatively. After resection of both gangrenous segment, colocolic anastomosis and double barrel ileostomy was performed. The postoperative course was uneventful, and patient was discharged on 7th postoperative day.

Ileosigmoid knotting: A rare cause of acute intestinal obstruction and peritonitis

“…Among these patients, SoBS was the most common reason for TPN; however, this estimate does not include patients with SoBS who are not getting TPN at home. It is unsuccessful as well [3,[13][14][15][16].…”

Ileosigmoid Knotting: A Case Series

“…However, enemas are only indicated in patients without evidence of peritonitis, gangrene, or perforation [4]. Unlike sigmoid volvulus, endoscopic reduction is contraindicated, as ileosigmoid knotting is a surgical emergency, and attempted endoscopic reduction may cause injury or perforation [1][2][3]10]. Management should begin as soon as the diagnosis is suspected.…”

“…Later, Shepherd named the condition "ileosigmoid knotting" in 1967. It has a male predominance, with a peak incidence during the third and fifth decades of life [ 2 , 3 ]. It is commonly encountered in areas with increased rates of sigmoid volvulus [ 4 ].…”

“…The etiology is not well established. However, the most predominant etiological factors are a long sigmoid colon with a narrow pedicle, a long small bowel mesentery with a freely mobile small bowel, and ingestion of a high-fiber, bulky diet with an empty small bowel [ 2 , 3 ]. Other contributing factors include late pregnancy, Meckel diverticulitis with thick bands, and ileocecal intussusception [ 3 ].…”

Sigmoid Volvulus and Ileosigmoid Knotting: An Update

“…Sigmoid volvulus (SV), the rotation of the sigmoid colon around its base ( Figure 1A ), is a relatively rare intestinal obstruction form worldwide, 1 - 4 while ileosigmoid knotting (ISK), the turning of the ileum or sigmoid colon around the other segment ( Figure 1B ), is extremely rare. 1 , 5 - 7 However, both SV and ISK are relatively common in Eastern Anatolia. 8 , 9 As a result of which, in our 56-year experience (from June 1966 to July 2022), the 1051-case SV series is the largest and the 80-case ISK series is the third largest monocenter patient serials in the world.…”