Ileosigmoidal knotting, an unusual form of acute intestinal obstruction

Abstract

Aim: Ileosigmoidal knotting is an unusual form of acute intestinal obstruction characterized by closed-loop obstruction of both ileum and sigmoid colon. We present 36 cases of ileosigmoidal knotting.Methods: A retrospective analysis was designed to examine preoperative, operative, and postoperative findings of the 36 patients with ileosigmoidal knotting who were surgically treated in Necmettin Erbakan University's Meram Medical Faculty (Konya, Turkey) throughout a 26-year period.Results: The mean age was 55 (range, 47-61) years. The most common symptoms were abdominal pain, distention, obstipation, and vomiting, and the most common signs were abdominal tenderness and distention. The preoperative diagnosis was acute obstructed bowel in all patients. After resuscitation, all patients underwent emergency laparotomy. The most common type of ileosigmoidal knotting was type IA, in which the active ileum encircled the passive sigmoid in a clockwise manner. There was gangrene in both ileum and sigmoid colon in all patients. All ischemic bowels including ileum and sigmoid colon were resected and the continuity was carried out using primary anastomosis or Hartmann's procedure. Conclusions:Ileosigmoidal knotting is a rare disease but its preoperative diagnosis is difficult. In cases of knotting there is no form of conservative treatment. Resective surgery is absolutely necessary.

Ileosigmoid Knotting: Analysis of Patients Clinical Profiles and Determinants of Outcomes

“…Similar to primary small bowel volvulus and sigmoid volvulus, for reasons not yet clear, ISK is predominantly a male disease. Our study, other studies from Ethiopia, and similar studies elsewhere showed a male to female ratio ranging 3 : 1 to 5 : 1 [ 1 , 3 , 6 , 10 – 12 , 15 , 18 ].…”

“…It is also common in Turkey [ 1 , 3 , 4 , 8 , 9 , 18 , 19 ]. The condition is seen in relatively young adults, and mean age ranges from 35.8 to 55 years, which is also the case in our study [ 1 , 3 , 4 , 6 – 11 , 13 , 15 ]. Similar to primary small bowel volvulus and sigmoid volvulus, for reasons not yet clear, ISK is predominantly a male disease.…”

“…This reflects lack of emergency surgical care in most of the rural Ethiopia. The major presenting features of ISK in our series were abdominal pain/tenderness, vomiting, failure to pass feces and/or flatus, abdominal distention, and hypoactive bowel, which are not different from findings of similar studies [ 1 – 4 , 6 – 11 , 15 , 18 , 19 ]. Shock is the presenting feature in up to 60% of the ISK patients [ 2 , 4 , 8 , 12 , 15 ].…”

“…It is reported that patients with ISK present relatively earlier but delays of up to 4 days is not uncommon. Literatures showed a mean duration of illness at presentation ranging 0.9–4.4 days [ 1 – 4 , 6 – 11 , 15 ]. Our patients mean (1.6 days) was in that range.…”

“…Even though a variety of procedures are performed to manage strangulation in ISK, the preferred is resection of gangrenous segments with primary anastomosis of the ilium and sigmoid end colostomy. In addition, stomas (colostomy or ileostomy) after resection can be performed as a salvage procedure in patients with poor general condition or with bowel problem such as edema and size discrepancy between proximal and distal bowel diameters [ 1 – 3 , 6 , 8 , 9 , 14 , 17 – 19 ].…”