Ileosigmoid knotting-A disastrous double closed loop obstruction

Abstract

Introduction: Ileosigmoid knotting (ISK) is a rare entity which needs prompt recognition and immediate surgical intervention to avoid catastrophic complications caused by gangrenous bowel and subsequent peritonitis. Preoperative investigations are only diagnostic of obstruction and CT findings are helpful but are not always available.

Presentation of case: This case report describes a 22 year old male presenting with acute abdomen managed with emergency exploration in view of findings of peritonitis. Intra-operatively an ileal segment was wrapped around the base of sigmoid colon with gangrenous ileal segment suggesting ISK. Resection of gangrenous ileal segment with double barrel ileostomy was done. Patient tolerated procedure well.

Discussion: Patients with ileosigmoid knotting present with frank obstruction and require immediate medical and surgical treatment. This condition rapidly progresses to gangrenous bowel, generalized peritonitis and sepsis with very high mortality.

Conclusion: Early diagnosis, prompt fluid resuscitation, preoperative antibiotics and immediate surgical exploration are keys for optimal management of this condition.

Keywords: Gangrenous bowel; Ileosigmoid knotting; Ileostomy; Obstruction; Peritonitis.

Fig. 1

Multiple air fluid levels with dilated bowel loops.

Fig. 2

Intraoperative findings (a) loop of ileum wrapping around dilated sigmoid colon. (b) Gangrenous ileum with dilated sigmoid colon after unwrapping twisted ileum.