Sir, Ileosigmoid knot is an unusual clinical entity of small bowel obstruction in which the ileum wraps around the base of the sigmoid colon and forms a pseudo knot. We present a case of a year-old man in whom the diagnosis of ileosigmoid knotting was made via emergency surgery. Our patient was a year-old man who arrived at the Emergency Department and was admitted with profound shock. He was complaining of acute worsening abdominal pain, vomiting and constipation for 2 days. Abdominal examination revealed a mildly distended abdomen with diffuse tenderness and positive rebound tenderness. No abdominal mass was palpable.
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Phone: , E-mail: moc. We are reporting a case of ileosigmoid knot in a year-old male, who presented with lower abdominal pain. On examination, there was tenderness in the suprapubic area and later, the patient developed features of peritonitis. Exploratory laparotomy revealed a large volume of haemorrhagic fluid with gangrenous sigmoid colon, distended and gangrenous ileum twisted round the base of the sigmoid loop.
It is an unusual clinical entity and a rare cause of intestinal obstruction [ 1 ]. This condition has a high incidence in east Africa, but it is rare in other parts of the world. It was first reported by Parker in Its incidence in the general population is not known, but it is most commonly seen in adult males and its peak incidence is in the fourth decade [ 2 ].
The condition is serious, generally progressing rapidly to gangrene of both ileum and sigmoid colon. Hence, an early diagnosis and operative treatment are vital [ 1 ]. Pre-operative diagnosis of this condition is difficult, because of its infrequency and atypical radiographic findings. Awareness of the condition is essential, for prompt diagnosis and optimal management. Case Report A year-old male was brought to the emergency department in the evening, with history of lower abdominal pain since 14 hours.
The patient was a known case of nephrolithiasis since 2 years. There was no history of constipation, dysuria, nausea or vomiting and fever. As the pain did not decrease with conventional analgesics, he was admitted to the Department of Surgery. On plain X-ray of abdomen erect and supine , no specific features were seen, except few distended large bowel shadows at the periphery. As there was no specific finding suggestive of any serious surgical condition, patient was managed conservatively with the suspicion of him having a urinary tract infection.
Initially, there was a slight decrease in pain, but by the next morning, patient became very distressed and he developed tachycardia, tachypnoea and hypotension. The abdominal tenderness and pallor increased. There was guarding and rebound tenderness. After vigorous resuscitation with administration of intravenous fluids, patient underwent emergency exploratory laparotomy.
On exploration, it was seen that there was large volume of haemorrhagic fluid in the peritoneal cavity, loops of small bowel were distended and gangrenous. The ileum and sigmoid were first decompressed and the knot was released.
During operation, one unit of blood and during immediate postoperative period, one unit of blood were transfused.
Corresponding author. Received Jan 18; Accepted Sep Abstract Ileosigmoid knotting, also known as compound volvulus or double Volvulus, is a rare cause of acute intestinal obstruction. In this condition the ileum wraps around the base of the sigmoid colon and forms a knot. The condition is serious, generally progressing rapidly to gangrene of both ileum and sigmoid colon. Ileosigmoid knotting is an unusual entity in the West, but is comparatively common in certain African, Asian and Middle Eastern nations. Awareness of the condition is essential for prompt diagnosis and optimal management.
Ileosigmoid knot: a case report and literature review of cases Skip to search form Skip to main content. Table 1 Clinical presentations and symptomatology as noted by various authors. Review of 68 cases. The condition progresses rapidly to gangrene, so early diagnosis and operative treatment are vital. CT scan reveals the classic whirl sign of volvulus created by the involved, twisted loops of ileosigmoie intestine and the mesocolon.
Ileosigmoid knot strangles the sigmoid
Selcuk Atamanalp, Prof. Abstract Ileosigmoid knotting ISK is the wrapping of the ileum around the sigmoid colon and its mesentery or vice-versa. The incidence of ISK is not well known, but it generally occurs in areas with a high incidence of sigmoid volvulus, and it is common in adult males. The etiology of ISK is controversial. The main symptoms are abdominal pain, distention, obstipation, and vomiting, while the main signs are abdominal distention and tenderness.