Compound volvulus: a case report and literature review

Abstract

Compound volvulus is an uncommon cause of acute abdomen and involves the twisting of the loops of ileum around the base of the sigmoid or vice versa. It is a surgical emergency that is often missed pre-operatively. We are reporting this case and reviewing the relevant literature to increase the awareness of this condition. A 37-year-old female presented at the Emergency Unit of our hospital with features thought to be acute peritonitis secondary to typhoid perforation and a differential of rupture appendix. She had laparotomy with the finding of a gangrenous twisted terminal ileum around the base of the sigmoid for which a right hemicolectomy and sigmoidopexy were done. Compound volvulus, though rare, can still be encountered in our environment. Prompt identification, adequate resuscitation and expedient intervention will reduce morbidity and mortality.

Factors triggering knot formation in ileosigmoid knotting

“…The presence of diarrhea anamnesis in a large amount of our patients supports this idea. Although some large series don't give information about the relationship between diarrhea and ISK, most likely due to the retrospective nature of the reports, 7,8 at least, a case report by Mba et al 9 supports this idea. Interestingly, in our series, premorbid diarrhea was more frequent in childhood ISK, the last which is an extremely rare pathology.…”

Sigmoid Volvulus and Ileosigmoid Knotting: An Update

“…Sigmoid volvulus goes by the name of “common volvulus” due to its relative frequency when compared to ISK. 3 Conversely, ISK is called as “rare,” “unusual,” or “unique volvulus.” 1 , 12 - 15 Other names of ISK arising from its complex anatomic stricture are “compound,” “double-loop volvulus,” or “gordion knot.” 16 - 19 …”

“… 35 , 52 Acute diarrhea, sudden and excessive movements (reaping, harvesting, coitus, and delivery), and overeating following prolonged starvation (Ramadan fasting) are the main precipitators. 2 , 6 , 16 , 43 , 52 , 55 - 61 …”

“…Increased intraabdominal volume pressure results in abdominal compartment syndrome. 2 , 16 , 18 , 20 , 24 …”

“… 2 , 4 , 24 , 27 , 28 , 37 , 56 , 59 , 62 , 63 , 66 In ISK, the unique difference is the localization of the above-mentioned sigmoid image generally in the right upper abdominal quadrant ( Figure 1F ) with an only 8%-10% of accuracy rate. 1 , 5 , 7 - 9 , 16 - 18 , 22 , 28 , 56 , 61 , 62 , 64 , 65 , 67 Computed tomography (CT) or magnetic resonance imaging (MRI), the last which is generally preferred in pregnant, are highly diagnostic with 85%-98% of accuracy rates in both SV and ISK by demonstrating mesenteric whirl sign in addition to abovementioned sigmoid image ( Figure 1G - J ). 1 , 2 , 4 , 7 , 40 , 42 , 53 , 56 , 62 - 67 Diagnostic endoscopy is also helpful in 75%-98% of SV cases by presenting a luminal twisting of the sigmoid colon lumen at a 20-30 cm distance from the anal verge ( Figure 1K ), while it remains incapable in the demonstration of ISK.…”