Ileosigmoid knot complicated by gastric and splenic mucormycosis: a lethal combination

Abstract

Two very rare conditions, ileosigmoid knot and intra-abdominal mucormycosis, occurred sequentially in a middle-aged HIV positive male.At laparotomy for peritonitis, a gangrenous sigmoid volvulus with ileosigmoid knot was resected; 2 days later, colo-rectal continuity was restored, the distal ileum stapled and an end jejunostomy fashioned.At re-laparotomy on day 15, necrotic stomach and spleen required a total gastrectomy and splenectomy. At reoperation 2 days later, a bile leak at the oesophago-jejunostomy site was repaired. Despite this intervention he continued to deteriorate and died of multiple organ failure 4 days later.

Infantile splenorenopancreatic mucormycosis complicating neuroblastoma

“…7 Spleen involvement has also been described in an adult woman with non-Hodgkin's lymphoma and a middle-aged man with HIV-seropositivity in whom dissemination developed from gastrointestinal mucormycosis. 8,9 In contrast to the present case, these scant cases involved adults in whom spleen infection was secondary to dissemination from other sites, rather than the initial presentation. Pancreatic mucormycosis has been infrequently reported.…”

“…Accordingly, in the present patient infiltration of hyphal fragments into blood vessels in tissue specimens was apparent. Despite the rare isolation of Mucor species from tissue cultures and abscesses, culture of the splenic and pancreatic biopsied specimen was positive in the present case. Culture was performed on Sabouraud's Dextrose agar as described in the literature .…”

Compound volvulus: An unexpected surgical finding

“…Of note, majority of the case reports indicate an operative finding of haemorrhagic peritoneal fluid associated with gangrenous bowel, as in the case described, the significance of this finding has not being investigated 2,4,5,7 .…”

“…Due to its common occurrence in Turkey (80 cases), they developed a new classification system which serves as a treatment algorithm and prognosticator 3 . To date there has only been one reported case of ISK in South Africa in a HIV positive patient that was complicated by mucormycosis which resulted in a mortality 5 . Below we describe a case in an academic hospital in South Africa in a HIV positive patient with a favourable outcome.…”

Near-fatal mucormycosis post-double lung transplant presenting as uncontrolled upper gastrointestinal haemorrhage

“…In 2001, a case of disseminated mucormycosis in a 16-year old patient with acute lymphoblastic leukaemia resulting in a splenic psuedoaneurysm was reported, that was successfully treated via splenectomy and therapy with amphotericin B [10] . In 2009 the post-mortem diagnosis of gastric and splenic mucormycosis was made in a middle-aged HIV-positive male who presented with an ileosigmoid knot [11] . A case of splenic and renal mycormycosis in a healthy host with no risk factors was published in 2010; the patient survived and was aggressively treated with radical debridement and amphotericin B [12] .…”