Ilio-sigmoid knotting in Addis Ababa: a three-year comprehensive retrospective analysis

Abstract

Background: Ileo-sigmoid knotting (ISK), formerly misnomered as Compound volvulus or double volvulus, is a condition where the distal ileum twists firmly around the sigmoid colon and its mesentery. It is usually associated with difficult preoperative diagnosis and poor surgical out come. Little is known about it in our country.

Objective: To assess the clinical presentations, clinical findings, operative treatments and post operative outcome of patients operated for ISK.

Design & setting: This is a retrospective review of patients' record with intra operative diagnosis of ISK over a period of three years between July 2002 and June 2005 who were operated on in the three teaching hospitals in Addis Ababa, Ethiopia, i.e. Tikur Anbassa Hospital (TAH), Princess Zewditu Memorial Hospital (ZMH) and St. Paul's Hospital (SPH).

Results: There were a total of 22 patients, of whom only 15 are reported due to lack of complete records. The majority were male Christians in their 4th and 5th decades. Abdominal cramp, vomiting, absolute constipation, abdominal distention and empty rectal ampulla were seen in all cases. The mean duration of illness was 83 hours. Fourteen patients had strangulated bowel which deserved resection and primary intestinal anastomosis for small bowel and end colostomy for the sigmoid colon. Post-operative complications were observed in nine patients, sepsis and septic shock being top in the list. Three patients died, making the mortality rate 20%.

Conclusion: Intestinal obstruction due to Ileo-sigmoid knotting is uncommon in Addis Ababa. Its clinical feature encompasses that of small and large bowel obstructions. Early presentation to surgical facilities aided by vigorous pre-operative resuscitation and appropriate surgical measure along with control of sepsis could reduce the accompanying high morbidity and mortality. Resection of the gangrenous small intestinal loop followed by primary anastomosis, and resection and end colostomy for the gangrenous sigmoid colon should be the preferred procedure. We believe that this study will increase the level of awareness amongst General surgeons and will serve as a way forward to establish a more rational and comprehensive approach to the problem.