Ileocecal knotting in a young man: A very rare and unique cause of intestinal obstruction

Gebresellassie, Hailu Wondimu

doi:10.1002/ccr3.3279

Cited by 2 publications

(19 citation statements)

References 10 publications

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“…In our patient, the operative findings were suggestive of ileocecal knotting, which is even a rarer variant. To the best of our knowledge, only three cases have been reported previously 4 , 6 , 8 (Table 1 ).…”

Section: Discussionmentioning

confidence: 97%

“…Intestinal knot syndromes are rare conditions in which bowel loops twist over one another, leading to the rapid deterioration of symptoms and a progressive loss of bowel viability 5 , 6 . Various types of knotting, such as ileosigmoid, appendico-ileal, ileoileal, and ileocecal knotting, have been reported, with ileosigmoid knotting being the most common 4 – 6 . In our patient, the operative findings were suggestive of ileocecal knotting, which is even a rarer variant.…”

Section: Discussionmentioning

confidence: 99%

“…Intestinal knotting results in an advanced bowel obstruction characterized by an increase in intramural pressure and hypovolemia. This leads to decreased mucosal perfusion, progressive bowel ischemia, and necrosis, subsequently causing peritonitis within a short time and resulting in high mortality 3 , 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Frequently encountered causes of small bowel obstruction include adhesions, hernias, neoplasms, Crohn’s disease, and small bowel volvulus 3 . Twisting of a loop of bowel with an intervening knot, described as intestinal knot syndrome, is a rare cause, with the even rarer subset being the ileocecal knot, where a loop of ileum wraps over the cecum and ascending colon 4 – 6 . This case has been reported in line with SCARE (Surgical CAse REport) 2023 guidelines 7 .…”

Section: Introductionmentioning

confidence: 99%

“…While certain clinical and radiological findings may offer clues, precise preoperative diagnosis of ileocecal knotting remains challenging. There is a rapid deterioration of the patient due to progressive bowel ischemia and necrosis, resulting in increased morbidity and mortality 3 , 6 . Thus, early intervention with prompt and aggressive management is necessary.…”

Section: Introductionmentioning

confidence: 99%

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Ileocecal knotting as a rare cause of small bowel obstruction: a case report

Dallakoti,

Pant,

Pokhrel

et al. 2024

Annals of Medicine &Amp; Surgery

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Introduction: Ileocecal knot syndrome, a rare cause of small bowel obstruction, where the ileum wraps around the cecum, poses a significant challenge for preoperative diagnosis. Prompt intervention is crucial due to the risk of rapid bowel deterioration and increased mortality. Case presentation: A 45-year-old female presented with central abdominal pain associated with vomiting, abdominal distension, and obstipation. On examination, she was ill looking with hypotension, tachycardia with a feeble pulse, direct and rebound abdominal tenderness, and absent bowel sounds. Aggressive fluid resuscitation was done. Based on the clinical presentation and abdominal radiograph suggestive of intestinal obstruction, an emergency exploratory laparotomy was done which showed an ileocaecal knot and 130 cm of gangrenous ileum. Peritoneal lavage followed by resection of non-viable ileum with double barrel ileostomy was done. Discussion: Ileosigmoid, appendico-ileal, ileoileal, and ileocaecal knotting are the various types of intestinal knotting, with very few cases of ileocaecal knotting being reported. Intestinal knotting causes severe bowel obstruction, resulting in reduced mucosal perfusion, progressive ischemia, and peritonitis, leading to high mortality. X-ray findings of multiple air-fluid levels are non-specific, and for definitive diagnosis, laparotomy is required. Assessing bowel viability before definitive surgery is essential. Despite positive outcomes, extensive resection can lead to malabsorption and ileus, with potential risk for developing short bowel syndrome. Conclusion: Despite its rarity, the possibility of ileocecal knotting should be considered in cases of small bowel obstruction due to its potential for rapid deterioration. Prompt resuscitation followed by emergency laparotomy is necessary to prevent mortality.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Ileocecal knotting as a rare cause of small bowel obstruction: a case report

Dallakoti,

Pant,

Pokhrel

et al. 2024

Annals of Medicine &Amp; Surgery

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Ileocecal Knotting Causing Intestinal Obstruction on Early Postpartum Period: Case Report

Daba,

Belete,

Getachew

2023

IMCRJ

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Introduction Intestinal knotting syndromes are rare causes of mechanical bowel obstruction, ileo-sigmoid knotting being the most common type. Ileocecal knotting is the rarest type among knot syndromes and there are few case reports across the world. Case Presentation We present a case of ileocecal knotting in a postpartum patient with abdominal distention, vomiting and failure to pass feces and flatus. Plain abdominal radiograph revealed dilated small bowel loops with multiple air fluid levels. Exploratory laparotomy was performed with intra-operative finding of ileocecal knotting with viable bowel, mobile cecum and ascending colon and gangrenous tip of appendix. We untied the knot and performed an appendectomy. Due to intra-operative instability of the patient’s vital signs, right hemicolectomy was differed and cecum as well as ascending colon were fixed to right posterolateral abdominal wall. Clinical Discussion Ileocecal knotting is a very rare finding, and few case reports have been published. The intra-operative findings of the mobile cecum and ascending colon are consistent with previous reports and it is a predisposing factor for knot besides low BMI and young age of our patient. Surgical management is dictated by intra-operative conditions such as viability of the bowel, intra-operative stability of the patient, extent of resection and length of the remaining bowel. Surgical options include en bloc resection of knot with gangrenous bowel and end to end anastomosis or end ileostomy with closure of distal end. Conclusion Ileocecal knotting should be considered as a differential diagnosis for patients presenting with intestinal obstruction with unusual radiographic findings. Early diagnosis and prompt surgical intervention prevents bowel infarction and enhance the prognosis. Preoperative abdominal CT scan is helpful in such cases with unusual radiographic findings.

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Ileocecal knotting in a young man: A very rare and unique cause of intestinal obstruction

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 2 publications

References 10 publications

Ileocecal knotting as a rare cause of small bowel obstruction: a case report

Ileocecal knotting as a rare cause of small bowel obstruction: a case report

Ileocecal Knotting Causing Intestinal Obstruction on Early Postpartum Period: Case Report

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