Ileosigmoid knot complicated by gastric and splenic mucormycosis: a lethal combination

Abstract

Two very rare conditions, ileosigmoid knot and intra-abdominal mucormycosis, occurred sequentially in a middle-aged HIV positive male.At laparotomy for peritonitis, a gangrenous sigmoid volvulus with ileosigmoid knot was resected; 2 days later, colo-rectal continuity was restored, the distal ileum stapled and an end jejunostomy fashioned.At re-laparotomy on day 15, necrotic stomach and spleen required a total gastrectomy and splenectomy. At reoperation 2 days later, a bile leak at the oesophago-jejunostomy site was repaired. Despite this intervention he continued to deteriorate and died of multiple organ failure 4 days later.

Figure 1

Operative findings of the necrotic small bowel and sigmoid colon.

Figure 2

Stomach histology and H&E stain showing necrotic background with distorted hypheal forms with large organisms (arrow).

Figure 3

Spleen histology: arterial wall showing the organisms on H&E stain (arrow).

Figure 4

Anatomic relationship of colon and small bowel.