Ileosigmoid knotting: experience from resource limited setup a retrospective review of cases at leku general hospital, sidama, Ethiopia

Abstract

Introduction; Ileosigmoid knotting is an uncommon cause of acute intestinal obstruction where the ileum wraps around the base of the sigmoid colon. The condition rapidly progresses to gangrene of the ileum and sigmoid colon.Due to the unfamiliarity of this entity and confusing and contradictory features of the disease preoperative exact diagnosis is not easy. Methodology ;this is a retrospective cross sectional 3years case management review of ileosigmoid knotting in Leku general hospital which is resource limited and district hospital and the aim is to share little experience in managing this cases, as well to add the existing data to the research community. Result; a total of only 5 ileosigmoid knotting cases were encountered in the last 3 years at Leku general hospital emergency surgery department.4 of the patients were male and the remaining 1case was female. The mean age was 43.8yrs.All the cases were presented with gangrenous bowel segment, both small bowel and sigmoid colon except, 1 viable sigmoid colon among. Resection and primary anastomosis done for all patients (both small bowel and sigmoid colon).No stoma done. All patients were discharged alive. Only 1 patient developed surgical site infection. Conclusion; Ileosigmoid knotting is very rare surgical emergency surgeons may encounter in their practice and should be considered as a cause of acute intestinal obstruction with strangulation. Adequate resuscitation and surgery improves prognosis. Based on the patients and bowel condition small bowel as well as colonic primary anastomosis has favorable outcome