Evaluation of clinical profiles, surgical experience and outcomes of ileosigmoid knotting in low-resource setup: A retrospective cohort study at Jimma University Medical Center.

BACKGROUND: Bowel obstruction is a mechanical or functional blockade of intestinal contents from evacuation to the adjacent distal bowel or external environment. It poses significant morbidity and mortality in both high-income and low-to-middle-income countries. Ileosigmoid knotting is a special form of obstruction where the small bowel often ileum wraps around the sigmoid colon or vice versa. It is the severest form of bowel obstruction, involving both the small and large bowels in a compound manner. It is common where sigmoid volvulus is common and geographic areas with a bulky diet. METHODS: An institution-based retrospective cohort study was employed among purposively selected 40 surgical patients with ileosigmoid knotting records from July 2020 to July 2023 at Jimma University Medical Center. To estimate and compare the survival probabilities, the Kaplan-Meir method and log-rank test were used. A Cox-regression analysis was fitted to identify independent predictors of time to death. RESULTS: Among a cohort of 40 patients followed for 347 person-days at Jimma University Medical Center, 11 (27.5%) had died. The overall incidence rate of death was 3.2 (95% CI 1.8, 5.7) per 100 person-days. In multivariable Cox-regression analysis, age (AHR = 1.15; 95% CI: 1.04-1.28), shock at presentation (AHR = 30.50: 95% CI 1.25-742.54), comorbidities (AHR = 5.81; 95% CI 1.19-28.23), pulse rate intraoperatively (AHR = 1.19; 95% CI: 1.01-1.40), postoperative pulse rate (AHR = 1.07; 95% CI: 1.01-1.14) were independently associated with time to death. CONCLUSION: The incidence of death among surgical patients with ileosigmoid knotting was high and also had a shorter median survival time. Age, shock at presentation, comorbidities, pulse rate intraoperatively, and postoperative pulse rate were found to be statistically significant predictors of time to death and outcome among surgical patients with Ileosigmoid knotting.

Ileosigmoid knotting: A review of 923 cases.

Objectives: Ileosigmoid knotting (ISK) is a rare intestinal obstruction form worldwide. The aim of this study was to investigate changing trends in ISK. Methods: The Web of Science and PubMed databases were electronically searched to find all publications to evaluate all epidemiological, etiological, clinical, laboratory, radiological, therapeutic, and prognostic factors in ISK. Results: Most of the cases were reported from Asian and African countries. Mean age was 43.9 years with a 79.9%/20.1% of male/female ratio. Main symptom period was 48.1 hours, while the most common clinical features were abdominal pain/tenderness (99.1%), distention (88.3%), and obstipation/constipation (58.8%). Abdominal X-ray radiography, computerized tomography (CT), and magnetic resonance imaging (MRI) were diagnostic in 8.2%, 96.2%, and 100.0%, respectively, while the total diagnostic accuracy rate was 20.8%. Bowels were gangrenous in 85.6% of the patients. Ileum resection was applied in 14.0% of the cases, while sigmoid colon resection in 7.6%, and both segment resection in 67.1%. The mortality rate was 22.7%, while the morbidity rate was also 22.7%. Conclusion: ISK is a rare disease, but it is still catastrophic despite its two-century recognised past. As an exception, diagnostic convenience arising from CT or MRI looks like the most important change over the last half-century.

Factors triggering knot formation in ileosigmoid knotting.

Objectives: Ileosigmoid knotting (ISK) is a rare double-loop ileus form. Therefore, its physiopathology including the triggering factors, are not well investigated. We aimed to discuss the physiopathology, particularly the triggering factors in ISK. Methods: The data of 80 patients with ISK were analyzed retrospectively until June 1986 and prospectively thereafter. As control group, the data of 80 patients with bowel obstruction arising from adhesive ileus or strangulated inguinal hernia were evaluated prospectively during the last 24 months. As probable triggering factors in ISK, the role of acute diarrhea, body motions, overeating, coughing, and labor were investigated. Results: Prior to the main clinical features of ISK, acute diarrhea (17 patients, 21.3%, p<0.05), harvesting (9 patients, 11.3%, p<0.05), and overeating (8 patients, 10.0%, p<0.05) were found effective. Conclusion: Although there is not enough data on this subject in the literature, increased bowel motility, excessive body motions, and overeating appear as the triggering factors in the forming of ISK.

Compound Volvulus: A Rare Case of Intestinal Obstruction.

Compound volvulus or ileosigmoid knotting is an uncommon surgical emergency that causes intestinal obstruction. The sigmoid and ileum are mostly involved in this closed-loop intestinal obstruction. It is regarded as a rather uncommon cause of intestinal obstruction. It's important to distinguish between an ileosigmoid knot and a simple sigmoid volvulus since the management of the two is different. CT and MRI are more helpful in the diagnosis than abdominal X-ray findings, which are not pathognomonic. After resuscitation, a patient with ileosigmoid knotting typically needs an emergency laparotomy. Different resectional and non-resectional surgical procedures may be employed depending on the viability of the ileum and sigmoid colon.

Pediatric Ileosigmoid Knotting: A Rare Culprit of Acute Abdominal Pain.

The present study focuses on ileosigmoid knotting (ISK), an infrequent but potentially lethal surgical emergency. ISK is more frequently observed in males and is prevalent in regions with high rates of sigmoid volvulus. The current medical scenario revolves around the intricate intertwining of the ileum and sigmoid colon, leading to a complicated volvulus. This condition often results in acute intestinal obstruction, which can subsequently cause bowel necrosis. The clinical presentation of the condition is characterized by symptoms such as abdominal distention, pain, vomiting, and obstipation, which can be misleading as they are similar to other common abdominal conditions. A delay in definitive diagnosis and intervention is likely, which can lead to severe consequences such as peritonitis, bowel necrosis, sepsis, and even septic shock. Our case report discusses an instance of ISK presenting as an acute abdomen requiring an emergency laparotomy and detorsion of the volvulus-knotted segment, followed by an elective sigmoidectomy. The significance of a heightened level of suspicion, prompt decision-making, and timely surgical intervention in achieving better patient outcomes cannot be overstated. The objective is to enhance the medical community's understanding of ISK, focusing on early diagnosis and effective treatment of this rare but life-threatening disease.

Ileosigmoid Knotting: A Case Series.

Ileosigmoid knotting is a rare case of intestinal obstruction that later leads to bowel necrosis. This is more common in males than females and seen more in areas with increased rates of sigmoid volvulus. The main clinical presentations are abdominal distention, abdominal pain and tenderness, vomiting, and obstipation. Definitive diagnosis is challenging due to its rarity and overlapping symptoms with other more common abdominal conditions. Delay in diagnosis and management can lead to peritonitis, necrosis of the bowel, sepsis, and eventually septic shock. Surgeons should consider ileosigmoid knotting in cases of acute abdomen, as it requires fast decision-making and intervention for a good prognosis. We present two cases of ileosigmoid knotting presenting with acute abdomen requiring emergent laparotomy with resection of necrotic bowel.

A rare cause of acute intestinal obstruction: Ileo-sigmoid knotting type IIA.

Ileosigmoid Knotting is a rare cause of intestinal obstruction which occurs as a consequence of ileum or sigmoid colon wrapping around the base of each other resulting in double closed-loop bowel obstruction. We report a case of a 52-year-old male who presented in the emergency department with sudden onset of abdominal pain and vomiting. On clinical examination, the abdomen was tender and distended. A chest and abdomen x-ray showed a distended stomach and no sign of bowel obstruction. A computed tomographic scan (CT) revealed a closed-loop intestinal obstruction. We planned urgent Surgery, and the finding was an Ileosigmoid knotting typeIIA is rarely encountered in surgical practice.

Comments on "Ileosigmoid knot in a patient with Down syndrome: a unique surgical emergency" by Boussaidane S et al. (Pan Afr Med J. 2021;38: 8).

Ileosigmoid knotting (ISK) is the wrapping of ileum or sigmoid colon around the other structure causing a double-loop intestinal obstruction. Both ISK and ISK complicating mental retardation are very rare clinical entities. In this commentary, I would like to discuss some details of ISK complicating mental retardation regarding to a published paper in The Pan African Medical Journal.

Ileosigmoid Knotting: A Rare Cause of Intestinal Obstruction and Bowel Ischemia-Case Report with Literature Review.

Ileosigmoid knotting, also known as compound volvulus or double volvulus, is a rare surgical emergency causing intestinal obstruction. Principally, it is a closed-loop intestinal obstruction that involves the sigmoid and ileum. It is considered a rare cause of intestinal obstruction. Differentiation of ileosigmoid knot from simple sigmoid volvulus is important because endoscopic decompression in ileosigmoid knot might be hazardous and even fatal. Endoscopic decompression of ileosigmoid knot may lead to perforation or injury. The mortality rate of ileosigmoid knot in general may reach 48%. We present a case of a 30-year-old male patient who presented with ileosigmoid knot at our emergency room. The aim of reporting this case is to increase understanding of the condition to promote earlier diagnosis.

A Challenging Case of Ileosigmoid Knotting in an Elderly.

Ileosigmoid knotting (ISK) is one of the rare causes of acute intestinal obstruction, which has a rapid course for forming gangrene. ISK is considered a variant of sigmoid volvulus, which otherwise is called compound volvulus. The difficulty in ISK diagnoses is owing to its rarity, uncommon presentation, and non-specific radiological findings. The physiological status of the patient and intraoperative findings are the key factors in deciding the operative procedure of choice. Herein the author describes a rare case of ISK in a 70-year-old man with gangrenous ileum and sigmoid colon, which were treated successfully with resection and double stoma.

A Case of Ileosigmoid Knotting in a Ghanaian Patient.

Ileosigmoid knotting is a rare condition in which a compound volvulus causes acute intestinal obstruction. In this process, the terminal ileum wraps around the base of the mesosigmoid and sigmoid colon, forming a knot. This condition tends to rapidly progress to gangrene of both the ileum and sigmoid colon; hence, the mainstay of treatment is timely emergency surgery. In this report, we describe the case of a 20-year-old Ghanaian female patient and discuss the available surgical options regarding ileosigmoid knotting.

[A case of ileosigmoid knotting in the postpartum period]. / Un cas de nœud iléo-sigmoïdien chez une femme en post-partum.

Ileosigmoid knotting is a rare cause of intestinal obstruction. We report a case of ileosigmoid knotting occurred during the postpartum period. The diagnosis was made by means of CT scan data and confirmed intraoperatively.

A rare occurrence of viability of both small and large bowel in ileosigmoid knotting: A case report.

INTRODUCTION: Ileosigmoid knot is an uncommon cause of acute intestinal obstruction where the ileum wraps around the base of a redundant sigmoid colon. CASE PRESENTATION: We present an unusual case of a 45-year-old male patient who presented with signs and symptoms of intestinal obstruction. Exploratory laparotomy revealed an ileosigmoid knot. Both the small and large bowels were viable. The sigmoid colon was resected an end to end anastomosis was done. His post-operative period was uneventful. DISCUSSION: Preoperative diagnosis of the condition is difficult. Diagnostic delays coupled with the infrequent occurrence of the condition often results in patients commonly presenting with gangrene of the ileum, sigmoid loop or both. There is considerable controversy regarding the optimal management of this rare condition. Management involves preoperative resuscitation, empirical antibiotics and prompt relief of the obstruction. The anatomical and pathological changes of the involved loops of bowel dictate the definitive surgical procedure. The vast majority of cases present with gangrenous loops of ileum, the sigmoid colon or both. To identify the presence of the ileum and sigmoid colon being viable on exploration is a rarity. CONCLUSION: The management of a patient who has both viable loops of bowel on exploration is a contentious issue. Traditional teaching dictates that untying of the knot should be coupled with resection of the sigmoid colon to negate the risk of a recurrence. Some case reports suggest that resection may not be necessary as the risk of recurrence is believed to be low.

Ileo-sigmoid knotting: a review of 61 cases in Kenya.

INTRODUCTION: Ileo-sigmoid knotting (ISK) is a rare cause of bowel obstruction in which the ileum twists around the sigmoid colon. It is associated with rapid bowel gangrene and a high mortality rate. Little has been published about this condition in Kenya. The objective was to determine the presentation, management, and outcome of patients with ISK. METHODS: A seven year (January 2008-December 2014) retrospective chart review of patients managed for ISK at Tenwek Hospital in Bomet, Kenya. RESULTS: A total of 61 cases were identified, with a mean age of 35.8 years (range 2-68), and mean symptom duration of 1.6 days (range 3 hours-7 days). Gangrene was noted to involve both the ileum and colon in 45 patients, the ileum only in 9 patients, and the sigmoid colon only in one. Resection and primary anastomosis was carried out in most cases of gangrenous ileum (48/54, 89%) and gangrenous sigmoid colon (34/46, 74%), while resection and stoma was performed in 8 patients with gangrenous colon. Death occurred in 7 (11.5%) patients due to severe sepsis and multisystem organ failure. Morbidities were noted in 15 (24.6%) patients, including surgical site infection (8, 13.1%), respiratory insufficiency (4, 6.6%), fascial dehiscence (3, 4.9%) and anastomotic leak (2, 3.2%). The mean duration of hospitalization was 8.3 days (range 1-26). CONCLUSION: In this review, though retrospective in nature, ISK was noted to have high rates of bowel gangrene. In the appropriate setting, resection and primary anastomosis can be safely carried out in most cases of gangrenous colon.

Ileosigmoid knotting in early pregnancy: A case report.

Ileosigmoid knotting refers to the wrapping of the ileum around the base of the sigmoid colon, or vice versa thus forming a knot. It is a rare cause of intestinal obstruction, more so in pregnancy. We herein report a case of a primigravid woman who presented with an acute abdomen at 13weeks of gestation. The patient underwent emergency surgery. Laparotomy showed ileosigmoid knotting with gangrenous loops of both small bowel and sigmoid colon. The gangrenous bowel was resected. Primary anastomosis of small bowel and a Hartman's procedure was performed.

Ileosigmoid knotting-A disastrous double closed loop obstruction.

INTRODUCTION: Ileosigmoid knotting (ISK) is a rare entity which needs prompt recognition and immediate surgical intervention to avoid catastrophic complications caused by gangrenous bowel and subsequent peritonitis. Preoperative investigations are only diagnostic of obstruction and CT findings are helpful but are not always available. PRESENTATION OF CASE: This case report describes a 22 year old male presenting with acute abdomen managed with emergency exploration in view of findings of peritonitis. Intra-operatively an ileal segment was wrapped around the base of sigmoid colon with gangrenous ileal segment suggesting ISK. Resection of gangrenous ileal segment with double barrel ileostomy was done. Patient tolerated procedure well. DISCUSSION: Patients with ileosigmoid knotting present with frank obstruction and require immediate medical and surgical treatment. This condition rapidly progresses to gangrenous bowel, generalized peritonitis and sepsis with very high mortality. CONCLUSION: Early diagnosis, prompt fluid resuscitation, preoperative antibiotics and immediate surgical exploration are keys for optimal management of this condition.