Ileosigmoid Knotting Causing Double Lumen Acute Intestinal Obstruction and Gangrene: Review and A Case Report

Ileosigmoid Knotting is a rare cause of intestinal obstruction. It is also called as compound volvulus or double volvulus. It is caused by the wrapping of the ileum around the sigmoid colon and its mesentery or vice-versa. It is a rapidly progressive condition, leads to acute intestinal obstruction and gangrene in ileum as well as in the sigmoid colon. Early diagnosis and intervention is the key to a better outcome. Due to the rarity and unfamiliarity of this entity, diagnosis is usually made intraoperatively. Surgical removal of the gangrenous segment with either stoma formation or anastomosis is the only hope.An additional systemic search of the literature was done in PubMed, MEDLINE, ISIS, Embase, and CAS searches with the following free text keywords: ileosigmoid knotting, intestinal knotting, compound volvulus and double volvulus in English literature. Around 64 studies were identified, out of which 38 studies were selected for this article after the removal of duplicates and unrelated articles. These case series and reports were reviewed for aetiopathogenesis, presentation, diagnostic modalities, surgical interventions, and outcome.Along with this review article, there was a case report of ileosigmoid knotting in a 38-year-old male patient that presented in the surgical Emergency Department; with complaints of generalised pain and distention of abdomen for two days. Also, he had complained of not passing flatus and motion for two days. On examination, patient had generalised tenderness and bowel sounds were absent. X-ray abdomen showed dilated small and large bowel with multiple air-fluid levels. After resuscitation, an emergency exploratory laparotomy was done, and the diagnosis of ileosigmoid knotting with gangrene of both ileum and sigmoid colon was made intraoperatively. After resection of both gangrenous segment, colocolic anastomosis and double barrel ileostomy was performed. The postoperative course was uneventful, and patient was discharged on 7th postoperative day.

Les Occlusions Intestinales Par Nœud Ileo-Sigmoïdien : Aspects Diagnostiques, Thérapeutiques Et Pronostiques

Introduction: Ileosigmoid knot (ISK), also known as compound volvulus or double volvulus, is a rare disease and affects mostly male subjects in their fourth decade. Delayed diagnosis often leads to complications with a high incidence of digestive necrosis. Materials and methods: This was a 10-year retrospective, descriptive and analytical study from 1 January 2007 to 31 December 2016, which covered all patients operated emergently for ISK in the surgical and surgical specialty departments at the Niamey National Hospital (NNH). Results: The series involved 8 cases of ISK, representing 0.82% of intestinal obstructions. There were 7 men and 1 woman. The average age of patients was 44.33 years with extremes ranging from 25 to 60 years. The main clinical signs were: abdominal pain (100%), inability to pass gas and stool (100%), vomiting (87.5%) and abdominal meteorism (87.5%). Four patients (50%) had a clear obstructive syndrome and the other 4 patients (50%) had associated signs of peritoneal irritation. Paraclinical diagnosis was difficult because of atypical clinico-radiological signs, but in all cases an abdominal x-ray was performed and showed a double loop of dilated sigmoid shadow in 87.5% of the cases. Laparotomy was the first approach used in all patients and led to a 50% necrosis rate. Hartmann’s colectomy and ideal colectomy were used in identical proportions, with 50% each. Ideal colectomy was characterized by a morbidity rate of 50% and a mortality rate of 25% compared to 0% for Hartmann’s procedure. The overall morbidity was 25% and the overall mortality was 12.5%. The average hospital stay was 65.87 days (range 17 to 128 days). The average time before reestablishment of digestive continuity was 50.37 days (range 31-128 days). Conclusion: Ileosigmoid knot is a rare condition at Niamey national hospital where the diagnostic approach is similar to that of occlusions in general, but remains difficult due to its uncommonness and atypical clinico-radiological signs. Necrosis rates and postoperative complications remain high.