Ileosigmoid Knot: A Case Report and Literature Review of 280 Cases

Abstract

Ileosigmoid knotting, also known as compound volvulus or double volvulus, is a rare cause of intestinal obstruction. In this condition the ileum wraps around the base of the sigmoid colon and forms a knot. Ileosigmoid knotting is an unusual entity in the West, but is comparatively common in certain African, Asian and Middle Eastern nations. The condition is serious, generally progressing rapidly to gangrene. Awareness of the condition is essential for prompt diagnosis and optimal management. This report describes a case in a 60-year-old male and describes the management of this rare condition. An additional 280 recent cases in the English literature are reviewed as to etiopathogenesis, presentation, diagnostic modalities, surgical interventions and outcome.

Volvulus of the Small Bowel and Colon

“…It is rare in the West, although few cases overall have been described in the literature. 46,47 Patients tend to be younger than those with sigmoid volvulus alone, and there is male predominance. 46,[48][49][50] Ileosigmoid knotting involves volvulus and obstruction of both the sigmoid and ileum.…”

“…Mortality for ileosigmoid knotting ranges generally between 20 and 30% overall; however, this depends greatly on bowel viability at the time of exploration. 46,48,50,51,54 Prompt recognition and surgical intervention is critical in the management of ileosigmoid knotting.…”

Management of Colonic Volvulus

“…First described by Parker in 1845, 57 only 280 cases have been described in the literature. 58 Patients who develop this condition are generally younger, often 40 to 50 years of age; it is more common in men. 59,60 It can progress quickly and cause gangrene of not only the sigmoid colon, but also the terminal ileum.…”

Ileosigmoid Knot—Unveiling the Diagnostic Dilemma with Radiologic Signs: A Case Report

“…The consumption of high bulk diet in presence of relatively empty small bowel has also been considered as a predisposing factor. 3,5,6 This condition is known to show higher incidence of occurrence among the male population in the fourth decade. 7 The patient presents with symptoms of acute abdominal pain and intestinal obstruction.…”

“…7 The patient presents with symptoms of acute abdominal pain and intestinal obstruction. 1,[6][7][8] Complications include hypovolemic shock, peritonitis, sepsis, and bowel gangrene. 1,7 ISK has been categorized into four types by Alver:…”