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Case Reports
. 2011 Apr;21(2):147-9.
doi: 10.4103/0971-3026.82301.

Ileosigmoid knot: A case report

Akshay D Baheti  1 , Darshana Patel, Priya Hira, Donald Babu
Affiliations
Case Reports

Ileosigmoid knot: A case report

Akshay D Baheti et al. Indian J Radiol Imaging. 2011 Apr.

Abstract

The ileosigmoid knot is an uncommon but life-threatening cause of closed loop intestinal obstruction. Its treatment is different from a simple volvulus in that it has to be operated upon immediately. Preoperative CT scan diagnosis and prompt treatment can lead to a good outcome. Findings of simultaneous ileal and sigmoid ischemia with non-ischemic colon interposed in between should, in an appropriate clinical setting, indicate this condition. The presence of the whirl sign, medially deviated distal descending colon and cecum, and mesenteric vascular structures from the superior mesenteric vessels that converge toward the sigmoid colon on CT scan help clinch the diagnosis.

Keywords: Compound volvulus; ileosigmoid knot; intestinal obstruction.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Abdominal radiograph reveals a large gas-filled loop of the bowel in the right mid and lower quadrants
Figure 2 (A–D)
Figure 2 (A–D)
Axial CT scan of the abdomen (A) shows a dilated loop of the sigmoid colon with a thinned-out wall (thin arrow). There is medial deviation of the cecum with a pointed medial border (thick arrow). Notice the normal intervening ascending colon (dotted arrow). (B) Caudal CT scan section shows the whirl sign (within the circle) created by the twisted mesentery and bowel (branches arising from the superior mesenteric artery are present in the whirl). There is medial deviation of the distal descending colon with a pointed medial border (thick arrow). Fluid-filled ileal loops with thin non-enhancing walls are seen (dotted arrow). (C) A more caudal CT scan section shows efferent limbs of the sigmoid colon (thick arrow) and the ileal loop (dotted arrow) with appearances of a beak. The whirl sign is present on this section as well (thin arrow). A further caudal CT scan (D) shows fluid-filled ileal loops in the pelvis with thin non-enhancing walls (solid arrow) and free fluid present in the pelvic cavity (dotted arrow)
Figure 3 (A, B)
Figure 3 (A, B)
Intraoperative photographs show a distended sigmoid colon (solid arrow) and gangrenous ileal loops (dashed arrow) wrapped around each other forming an ileosigmoid knot
Figure 4
Figure 4
Diagrammatic illustration of the ileosigmoid knot. The long arrow points to the knot while the short arrows point to the medial displacement of the descending colon and cecum
See this image and copyright information in PMC

References

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