Ileosigmoid knotting: One of the largest single-center series

Abstract

Ileosigmoid knotting (ISK) is the wrapping of the ileum or sigmoid colon around the base of the other structure, causing a double-loop intestinal obstruction. The disease generally presents as an intestinal obstruction with volvulus triad, including abdominal pain/tenderness, distention, and obstipation. Abdominal X-ray findings are not pathognomonic, and computerized tomography (CT) and magnetic resonance imaging (MRI) are more useful in the diagnosis. A patient with ISK generally requires an emergency laparotomy following resuscitation. Based on the viability of the ileum and sigmoid colon, different resectional or non-resectional surgical techniques may be used. In this report, one of the largest single-center ISK series in the world, an eighty-case series, is concisely presented.

A Challenging Case of Ileosigmoid Knotting in an Elderly

“…The reported mortality from ISK varies from 0% to 48% [5]. Higher mortality has been observed in patients with old age (<60 years), delayed presentation (>24 hours), and the presence of gangrenous bowel [3]. Considering the presence of the above high-risk factors in our patient along with bowel edema and luminal discrepancy, resection of the gangrenous segments with end ileostomy and Hartmann's procedure was performed in this case.…”

“…ISK is one of the uncommon but potentially life-threatening causes of bowel obstruction, in which a portion of the ileum and sigmoid colon wrap around each other, forming a closed-loop obstruction. It is commonly seen in the Africa, Asia, and the Middle East populations, with a male preponderance and mean age of presentation around 40 years [2,3]. Endemicity of the disease has also been reported in Turkey, specifically in Eastern Anatolia.…”

Ileosigmoid knot in a patient with Down syndrome: a unique surgical emergency: a case report

“…Our case of ISK in a young man with Down's syndrome makes for a rare diagnosis. Atamanalp [ 4 ] suggested that high altitude, high-fiber diet habits, male gender and advanced age are known as probable causes of an anatomical predisposition to ISK, namely, an elongated sigmoid colon with a narrow mesentery in addition to a hypermobile terminal ileum. In our case, we can suggest the presence of congenital mega-colon which is part of the malformations of the digestive tract in Down's syndrome as an anatomical cause of ISK [ 5 ].…”

“…The preoperative diagnosis is difficult because of its rarity and clinico-radiological atypia, it is possible in less than 20% of cases [ 3 ]. Abdominal pain is constant, often sub-acute and progressive, associated with obstipation (98.8-100%), abdominal distension (94-100%), nausea and vomiting (77.5-100%) and rebound tenderness (36.8-100%) [ 4 , 6 , 7 ]. Abdominal X-ray may show disproportionate distension with large air-fluid levels in the sigmoid colon occupying the right side of the abdomen, with multiple air-fluid levels of the small intestine on the left side of the abdomen [ 3 ].…”

The role of Ataturk University in data and publication production for sigmoid volvulus and ileosigmoid knotting

“…Turkey, particularly our region, Eastern Anatolia, is endemic for SV and ISK 1-4. The plausible causes of this interesting dispersion include a diet high in fibre and vegetables and the high altitude, which cause a redundant sigmoid colon with a narrow mesentery, an anatomical feature that is known to be a predisposing factor for SV and ISK 8-10. As a result of our comprehensive experience with SV and ISK, our clinic has produced many publications on these topics over the years.…”