Ileo-sigmoid knotting- an unusual cause of intestinal obstruction: A case report

INTRODUCTION AND IMPORTANCE: Ileosigmoid knotting is an unusual cause of intestinal obstruction in which the ileum wraps around the base of the sigmoid colon and its mesentery, which leads to a closed loop intestinal obstruction. PRESENTATION OF CASE: A 59-year-old male patient was referred to our center with acute abdominal pain, obstipation and a few episodes of vomiting. On physical examination, he had hypotension and tachycardia as well as distension, diffused tenderness, guarding and rebound tenderness of the abdomen. Bowel sounds were absent. Abdominal Plain X-ray showed dilatation of the large bowel associated with the distended small bowel. After resuscitation with aggressive intravenous fluid therapy, the patient underwent an emergency laparotomy. Exploration revealed gangrene of the intestinal loops, including the jejunum and ileum, which was secondary to a 360° clockwise twisting of the ileal loops around the sigmoid colon. Gangrene of the sigmoid colon along with torsion of the superior mesenteric arteries was also obvious. Resection of the gangrenous loops of the small bowel as well as a sigmoidopexy was carried out and a primary anastomosis of the small intestine and colon was performed. He did well post-operatively. CLINICAL DISCUSSION: It is crucial to distinguish Ileosigmoid knotting from sigmoid volvulus because it can rapidly, even within hours, progress to bowel gangrene and peritonitis; moreover, in this situation the endoscopic reduction is contraindicated. CONCLUSION: Ileosegmoid knotting is an unusual cause of bowel obstruction which has relatively high mortality rates and should be considered in patients with acute abdominal pain and presentations of bowel obstruction.