Compound Volvulus: A Rare Case of Intestinal Obstruction

Abstract

Compound volvulus or ileosigmoid knotting is an uncommon surgical emergency that causes intestinal obstruction. The sigmoid and ileum are mostly involved in this closed-loop intestinal obstruction. It is regarded as a rather uncommon cause of intestinal obstruction. It's important to distinguish between an ileosigmoid knot and a simple sigmoid volvulus since the management of the two is different. CT and MRI are more helpful in the diagnosis than abdominal X-ray findings, which are not pathognomonic. After resuscitation, a patient with ileosigmoid knotting typically needs an emergency laparotomy. Different resectional and non-resectional surgical procedures may be employed depending on the viability of the ileum and sigmoid colon.

Keywords: compound volvulus; double close loop obstruction; emergency laparotomy; ileosigmoid knotting; intestinal obstruction.

Figure 1. X-ray abdomen-dilated small and large bowel loops.

Arrow showing dilated bowel loops.

Figure 2. Laparotomy showing gangrenous sigmoid colon.

Arrow showing gangrenous segment.

Figure 3. Preoperative distal loopogram with contrast inserted through transverse loop colostomy (Image A) and rectal contrast (Image B)

Image A - colostomy, no dye leak. Image B - rectum with no dye leak.

Figure 4. Laparotomy showing twisting of ileum and sigmoid colon with gangrenous changes.

Blue arrow - sigmoid loop. White arrow - ileal loops. Black arrow - Axis of knotting.

Figure 5. The patient at 14 weeks of surgery. End ileostomy (blue arrow), transverse colon mucus fistula (white arrow) on the right side with descending colon mucus fistula (black arrow) on the left side.