Ileosigmoid knot

Abstract

Ileosigmoid knotting, also known as compound volvulus or double Volvulus, is a rare cause of acute intestinal obstruction. In this condition the ileum wraps around the base of the sigmoid colon and forms a knot. The condition is serious, generally progressing rapidly to gangrene of both ileum and sigmoid colon. Ileosigmoid knotting is an unusual entity in the West, but is comparatively common in certain African, Asian and Middle Eastern nations. Awareness of the condition is essential for prompt diagnosis and optimal management. This article will focus on the etiopathogenesis, presentation, diagnostic modalities, surgical interventions and outcome with review of articles and case reports published till date.

Keywords: Compound volvulus; Ileosigmoid knot; Intestinal obstruction.

Fig. 1

Mechanism of ISK formation

Fig. 2

a Supine X-ray. Dilated sigmoid loop (small arrow), medially deviated and distended descending colon (large arrow) and dilated loops of small intestine (arrow head). b Line diagram showing anatomical relations in ileosigmoid knot

Fig. 3

a CT shows dilated loop of ileum (white arrow head) with mesenteric whirl sign (arrow) and medially deviated descending colon and cecum (black arrow head). b Gas filled ileal loop (arrow head) and whirl sign (small arrow) and distended sigmoid colon (large arrow)

Fig. 4

Ileosigmoid knot with gangrenous terminal ileum (arrow) and sigmoid colon (arrow head)

Fig. 5

a Straight X-ray Abdomen showing Typical Sigmoid volvulus. b Line diagram showing anatomical relations in Sigmoid Volvulus