Ileosigmoid knotting: A report of two cases

Abstract

Background: Ileosigmoid knotting (ISK) is a rare cause of acute intestinal obstruction with high morbidity and mortality. The diagnosis is rarely made preoperatively because of its infrequency and the variations in presentation.
Aim: To report two cases managed by the author, which will hopefully increase awareness of this condition.
Case Reports: The first was a 51-year-old man who presented with a sudden onset of colicky lower abdominal pain, which later became generalized. His pulse rate was 100 beats/minute while his blood pressure was 80/60 mmHg.There was mild abdominal distension with absent bowel sounds. The second was a 50-year-old man with a sudden onset of generalized colicky abdominal pain, abdominal distension and vomiting. His pulse rate was 120 beats/minute and the blood pressure 80/50 mmHg. His bowel sounds were markedly reduced. They were resuscitated accordingly. In both patients, exploratory laparotomy revealed a copious amount of sero-sanguinous fluid in the peritoneal cavity with ileosigmoid knotting, and extensive gangrene involving the distal ileum and the sigmoid colon. In the first patient, the caecum was involved in the knot and therefore also gangrenous. Each of them had a sigmoid colectomy with a right hemicocetomy. The first patient died of adult respiratory distress syndrome while the other had an uneventful recovery. In the patient who died, surgery was done on the third day of onset of symptoms.
Conclusion: A high index of suspicion, aggressive resuscitation, and prompt surgical intervention are indispensable for a successful outcome.


Port Harcourt Medical Journal Vol. 1 (3) 2007: pp. 197-200