The ileosigmoid knot

Abstract

The ileosigmoid knot (ISK) is a rare cause of intestinal obstruction. Unfamiliarity with the condition could have disastrous consequence at surgery. Over the past 20 years, we have encountered seven cases. Analyzing the data gathered from these, and on reviewing the literature, we found it possible to arrive at a preoperative diagnosis in two patients. Four patients were women, two of whom developed the obstruction in the postpartum period. One of the males was found to have an inflamed Meckel's diverticulum included in the knotting. The symptoms and the clinical findings were nonspecific. The characteristic x-ray findings of a double closed loop obstruction, was seen in only three patients. Resection of gangrenous bowel with anastomoses was feasible in four. Unlike in other series, primary anastomosis of the large gut was undertaken. There were two deaths early in the series. Guidelines to the management have been suggested.

The Unusual Volvulus : A Five Year Retrospective Analysis of Nine Cases

“…Three factors are responsible for the ileosigmoid knot: a long small bowel mesentery and freely mobile small bowel, a long sigmoid colon on a narrow pedicle, and finally the ingestion of a high-bulk diet in the presence of an empty small bowel [2,7,8,11]. When a semifluid bulky meal progresses into the proximal jejunum, it increases the mobility of the intestine and the heavier segments of the proximal jejunum fall into the left lower quadrant.…”

“…Unfamiliarity with this condition can have disastrous consequences at surgery [2]. Owing to its rarity, personal experience with this condition is often limited to a few cases with majority of the studies being retrospective reviews of hospital records [3].…”

Gangrene of Large Bowel Due to Volvulus-Etiopathogenesis, Management and Outcome

“…Generalized peritonitis ,sepsis and dehydration are the principal complications (Shepherd JJ 1967, Puthu D 1991, Alver O 1993, Raveenthiran V 2001. The predominant symptom and signs of presentation include abdominal pain and tenderness (100%), abdominal distension (94 to 100%), nausea and vomiting (87 to 100%), rebound tenderness (69%) and shock (0 to 60%) ( Shepherd JJ 1967, Puthu D 1991, Alver O 1993, Raveenthiran V 2001. Despite the critical condition the preoperative diagnosis is not easy.…”

“…Ileosigmoid knotting is a rare cause of intestinal obstruction that rapidly progresses to gangrene of ileum as well as the sigmoid colon (Shepherd JJ 1967,Puthu D 1991, Alver O 1993. Preoperative diagnosis is difficult because of its infrequency and atypical radiographic findings (Shepherd JJ 1967).…”

“…In recent years CT has been useful in making a preoperative diagnosis (Raveenthiran V 2001). Generalized peritonitis and sepsis are the main cause of poor outcome (Shepherd JJ 1967, Puthu D 1991, Alver O 1993. After hemodynamic stabilization, immediate surgical intervention is need of the hour.…”