Ileosigmoid knotting: A case report of unique cause of acute abdomen in a Nepalese patient

Abstract

Introduction and importance Ileosigmoid knotting is a surgical emergency. Common in Asian males, it is presented with signs and symptoms of diffuse peritonitis. Aggressive resuscitation with intravenous fluids and antibiotics followed by workup enable the patient hemodynamically stable. Explorative laparotomy followed by colo-colic anastomosis and double barrel ileostomy is curative. Case presentation A 32-year-old-male from Nepal with a chief complain of diffuse abdominal pain for a day and signs of peritonitis presented to Emergency room. After assessing and stabilizing the patient, explorative laparotomy was performed. Ileal and sigmoid resection followed by colo-colic anastomosis and double barrel ileostomy was done. On regular follow-up, he is in his usual state of health. Discussion The incidence of ileosigmoid knotting is reported to be about 1.6 cases per year. It is often misdiagnosed as non-specific intestinal obstruction which confers poor prognostic value to the patient. It should be identified promptly and intervened timely. Conclusion Ileosigmoid knotting is a rare but dangerous differential of acute abdomen not to be missed. Early assessment and quick decision making is the key to provide excellent prognosis to the patient in need, provided adequate surgical skills are demonstrated.

Ileosigmoid Knotting: A Case Series

“…However, enemas are only indicated in patients without evidence of peritonitis, gangrene, or perforation [4]. Unlike sigmoid volvulus, endoscopic reduction is contraindicated, as ileosigmoid knotting is a surgical emergency, and attempted endoscopic reduction may cause injury or perforation [1][2][3]10]. Management should begin as soon as the diagnosis is suspected.…”

“…Later, Shepherd named the condition "ileosigmoid knotting" in 1967. It has a male predominance, with a peak incidence during the third and fifth decades of life [ 2 , 3 ]. It is commonly encountered in areas with increased rates of sigmoid volvulus [ 4 ].…”

Ileo-sigmoid knotting- an unusual cause of intestinal obstruction: A case report

“…Anatomical abnormalities such as redundant sigmoid colon with a narrow mesenteric pedicle, elongated small intestine mesentery, hypermobile small bowel, have been theoretically responsible for the occurrence of ISK [1] . Other than these anatomical factors, Meckel diveticulitis with band, ileocecal intussusceptions, floating cecum and trans-mesenteric herniation are risk factors for ISK [2] , [6] . Our patient was a Muslim male who presented with ISK during Ramadan.…”

“…Since most patients with ISK present with frank obstruction, the mortality rate of ISK is relatively high and estimated about 48 % [1] , [2] . Keys for appropriate management are Prompt intravenous fluid resuscitation, correction of the acid-base and electrolyte imbalance, empiric antibiotic therapy (with aminoglycosides and cephalosporins) and immediate surgical exploration [1] , [2] .…”

“…This situation, also known as compound volvulus, leads to a closed loop intestinal obstruction. It may briskly progress to gangrene in both the ileum and the sigmoid colon within hours; thereupon, peritonitis and resultant sepsis with high mortality can occur [1] , [2] .…”