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Review
. 2009 Aug;41(2):116-9.

Ileosigmoid knotting

S Selcuk Atamanalp  1
Affiliations
Review

Ileosigmoid knotting

S Selcuk Atamanalp. Eurasian J Med. 2009 Aug.

Abstract
in English, Turkish

Ileosigmoid knotting (ISK) is the wrapping of the ileum around the sigmoid colon and its mesentery or vice-versa. The incidence of ISK is not well known, but it generally occurs in areas with a high incidence of sigmoid volvulus, and it is common in adult males. The etiology of ISK is controversial. The main symptoms are abdominal pain, distention, obstipation, and vomiting, while the main signs are abdominal distention and tenderness. There are no specific blood tests for diagnosing ISK. Plain abdominal X-ray radiographs demonstrate a dilated sigmoid colon and multiple small intestinal air-fluid levels. Abdominal CT demonstrates a twisted and dilated sigmoid colon with whirled sigmoid mesentery, in addition to twisted and dilated small intestinal segments. The accurate preoperative diagnosis of ISK is difficult. After rapid and prompt resuscitation, emergency surgery is needed in the treatment of ISK. In gangrenous cases, resection with primary anastomosis is preferred, while, in nongangrenous cases, untying of the knot may be performed as a sole surgical procedure, or a volvulus-preventing procedure may be added. The mean mortality rate for ISK is 6.8-8% in nongangrenous and 20-100% in gangrenous cases.

İleosigmoid düğümlenme (İSD), ileum veya sigmoid kolonun diğeri ve onun mezosu etrafında dönmesidir. İSD’nin görülme sıklığı çok iyi bilinmez, fakat genel olarak sigmoid volvulusun yüksek oranda görüldüğü yerlerde görülür ve erişkin erkeklerde daha sıktır. İSD’nin etiyolojisi tartışmalıdır. Başlıca belirtiler karın ağrısı, şişkinlik, gazgaita çıkaramama ve kusma iken başlıca bulgular karında şişkinlik ve hassasiyettir. İSD tanısı koyduracak spesifik bir kan testi yoktur. Düz karın radyografisi genişlemiş bir sigmoid kolon ve çok sayıda ince barsak hava-sıvı seviyelerini gösterir. Karın CT’si dönmüş mezenteri ile birlikte dönmüş ve genişlemiş sigmoid kolonu, ek olarak dönmüş ve genişlemiş ince barsak segmentlerini ortaya koyar. Ameliyat öncesi dönemde İSD’nin doğru tanısı güçtür. İSD’nin tedavisinde hızlı ve uygun bir resusitasyondan sonra acil cerrahi gerekir. Gangrenli olgularda rezeksiyon ile primer anastomoz tercih edilir, gangrensiz olgularda ise tek işlem olarak düğümlenmenin çözülmesi uygulanabilir veya volvulus önleyici bir işlem eklenebilir. İSD’nin ortalama mortalitesi gangrensiz olgularda % 6.8–8 iken gangrenli olgularda % 20–100’dür.

Keywords: Ileum; Knotting; Sigmoid colon.

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Figures

Fig. 1
Fig. 1
Schematic diagram of ISK.
Fig. 2
Fig. 2
Plain erect abdominal x-ray film in ISK (a dilated sigmoid colon and multiple small intestinal air-fluid levels).
Fig. 3
Fig. 3
Operative appearance of ISK (a twisted and dilated sigmoid colon with twisted and dilated ileal segments).
See this image and copyright information in PMC

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