Ileosigmoid knotting in a child: Index case in Botswana and review of the literature

Abstract

Ileosigmoid knotting (ISK) is a rare form of complex intestinal obstruction where a loop of ileum wraps around the base of the sigmoid colon, or vice versa. We report the case of an ill-looking 8-year-old boy who presented with abdominal pain and vomiting. Abdominal examination revealed distension and features of diffuse peritonitis. Complicated appendicitis was at the top of the list of differential diagnoses. The patient was resuscitated and prepared for surgery. At laparotomy, haemorrhagic fluid with gangrenous ileum wrapping around gangrenous sigmoid colon was found. En bloc resection of the gangrenous ileum and sigmoid colon with primary ileo-ileal and descending colorectal anastomoses were done. The patient was discharged on the 10th postoperative day. Although extremely rare in this patient population, surgeons must be able to recognise and manage ISK in children.