A Challenging Case of Ileosigmoid Knotting in an Elderly

Singh, Pradeep Kumar; Ali, Manwar S; Manohar, Das Birendra; Sethi, Mahesh

doi:10.7759/cureus.9624

Cited by 6 publications

(9 citation statements)

References 9 publications

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“…Ileosigmoid knot ethology is influenced by three variables: Three conditions have been identified: (I) a long small bowel mesentery with a free-moving small bowel; (ii) a long sigmoid with a narrow pedicle; and (iii) a large diet combined with an empty small bowel. According to certain research, a large diet may move up to the proximal jejunum, where it may improve small bowel movement and land in the left lower quadrant of the abdomen [6][7][8]. Small bowel loops have the ability to rotate around the sigmoid tight pedicle.…”

Section: Discussionmentioning

confidence: 99%

Ileosigmoid knotting: A rare cause of acute intestinal obstruction and peritonitis

Y Kidane

2024

J Case Rep Images Surg

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Introduction: Ileosigmoid knotting (ISK) is one of the rarer causes of bowel obstruction compared to others. This is also called compound volvulus or double loop obstruction. The presentation symptoms are similar to those of other large bowel or distal intestinal obstructions. But the pathogeny’s or disease’s progression is rapid. So the patient develops ischemia or strangulation of the involved segment of the bowel earlier than the sigmoid or ceal volvulus. One of the challenges of the disease is that, especially in low-income countries like ours, there is no access to contrast computed tomography (CT), which is more sensitive diagnostic imaging. Case Report: A 58-year-old male patient presented to our hospital with abdominal pain for two days. He was referred from the primary hospital. The pain was initially central and later diffused to other parts of the abdomen. Associated with this, he was vomiting of ingested matter for more than two episodes. On physical examinations, he was in acute pain, and his vital signs showed a pulse rate of tachycardia at 127 BPM. On abdominal examination, he had distention and diffused tenderness with gardening. So we diagnosed him with peritonitis secondary to gangrenous sigmoid volvulus obstruction (SVO). So I chose the imaging that is available in our hospital, a plain abdominal X-ray. So the patient was resuscitated with normal saline, an antibiotic was initiated, and he was taken to the operation after giving consent. The ilium and sigmoid colon were gangrened and en bloc resection was done, and the jejunum and remaining 7 cm of ilium from the ileocecal valve were anastomosed. The patient was taken to or for a relook, and the anastomosis was disrupted, then refreshed, and both the proximal and distal segments were taken out as stomas. The output was significant and later developed a controlled entrocutaneous fistula, which was closed after three weeks. Conclusion: The prognosis is poor for ISK compared to other common types of volvulus and worse prognosis challenging management in conditions with both active and passive bowel ischemia which happened to our patients. Diagnosis is also challenging before the surgery. The abdominal X-ray and ultrasound are available and commonly the surgeon commonly will not send for this unless the patient is stable. Blind rectal tube deflation the common intervention in our setup with no access for sigmoidoscopy is not indicated for this non-surgical initial management rather with a highly suspicious diagnosis early resuscitation with early surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Ileosigmoid knotting: A rare cause of acute intestinal obstruction and peritonitis

Y Kidane

2024

J Case Rep Images Surg

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“…There is no clear decision about the surgical procedure for ileosigmoid knotting [ 3 , 4 ]. Some authors advocate for untwisting the knot after enterotomy if both ileal and sigmoid bowel loops are viable [ 11 ]. Untwisting the knot can be difficult and risks the release of toxins and perforation.…”

Section: Discussionmentioning

confidence: 99%

“…A primary colorectal anastomosis and/or primary enteroenterostomy are feasible if both local and general conditions allow. Otherwise, an ileostomy or colostomy is required [ 4 , 10 , 11 ]. In each of our cases, untwisting of the knot was not possible, and a primary colorectal anastomosis with a small bowel ostomy was performed.…”

Section: Discussionmentioning

confidence: 99%

Ileosigmoid Knotting: A Case Series

Sseruwagi¹,

Lewis²

2022

Cureus

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Ileosigmoid knotting is a rare case of intestinal obstruction that later leads to bowel necrosis. This is more common in males than females and seen more in areas with increased rates of sigmoid volvulus. The main clinical presentations are abdominal distention, abdominal pain and tenderness, vomiting, and obstipation. Definitive diagnosis is challenging due to its rarity and overlapping symptoms with other more common abdominal conditions. Delay in diagnosis and management can lead to peritonitis, necrosis of the bowel, sepsis, and eventually septic shock. Surgeons should consider ileosigmoid knotting in cases of acute abdomen, as it requires fast decision-making and intervention for a good prognosis. We present two cases of ileosigmoid knotting presenting with acute abdomen requiring emergent laparotomy with resection of necrotic bowel.

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“…The 5- and 10-year cumulative risk of colectomy (emergence or elective) is 10–15%, primarily limited to patients with moderate to severe disease activity; a subset of hospitalized patients with acute severe UC (ASUC), also called fulminant UC, have short-term colectomy rates of 25–30% [ 47 , 78 , 79 , 80 , 81 ]. In some cases, it is not possible to maintain a pouch due to subsequent complications; in this case, a permanent terminal ileostomy may be required [ 44 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Inflammatory Bowel Disease: Clinical Diagnosis and Surgical Treatment-Overview

M’Koma

2022

Medicina

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This article is an overview of guidelines for the clinical diagnosis and surgical treatment of predominantly colonic inflammatory bowel diseases (IBD). This overview describes the systematically and comprehensively multidisciplinary recommendations based on the updated principles of evidence-based literature to promote the adoption of best surgical practices and research as well as patient and specialized healthcare provider education. Colonic IBD represents idiopathic, chronic, inflammatory disorders encompassing Crohn’s colitis (CC) and ulcerative colitis (UC), the two unsolved medical subtypes of this condition, which present similarity in their clinical and histopathological characteristics. The standard state-of-the-art classification diagnostic steps are disease evaluation and assessment according to the Montreal classification to enable explicit communication with professionals. The signs and symptoms on first presentation are mainly connected with the anatomical localization and severity of the disease and less with the resulting diagnosis “CC” or “UC”. This can clinically and histologically be non-definitive to interpret to establish criteria and is classified as indeterminate colitis (IC). Conservative surgical intervention varies depending on the disease phenotype and accessible avenues. The World Gastroenterology Organizations has, for this reason, recommended guidelines for clinical diagnosis and management. Surgical intervention is indicated when conservative treatment is ineffective (refractory), during intractable gastrointestinal hemorrhage, in obstructive gastrointestinal luminal stenosis (due to fibrotic scar tissue), or in the case of abscesses, peritonitis, or complicated fistula formation. The risk of colitis-associated colorectal cancer is realizable in IBD patients before and after restorative proctocolectomy with ileal pouch-anal anastomosis. Therefore, endoscopic surveillance strategies, aimed at the early detection of dysplasia, are recommended. During the COVID-19 pandemic, IBD patients continued to be admitted for IBD-related surgical interventions. Virtual and phone call follow-ups reinforcing the continuity of care are recommended. There is a need for special guidelines that explore solutions to the groundwork gap in terms of access limitations to IBD care in developing countries, and the irregular representation of socioeconomic stratification needs a strategic plan for how to address this serious emerging challenge in the global pandemic.

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A Challenging Case of Ileosigmoid Knotting in an Elderly

Cited by 6 publications

References 9 publications

Ileosigmoid knotting: A rare cause of acute intestinal obstruction and peritonitis

Ileosigmoid knotting: A rare cause of acute intestinal obstruction and peritonitis

Ileosigmoid Knotting: A Case Series

Inflammatory Bowel Disease: Clinical Diagnosis and Surgical Treatment-Overview

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