The ileosigmoid knot: new observations and changing trends

Area of Science:

• Gastroenterology
• Surgical Emergency
• Abdominal Surgery

Background:

• Ileosigmoid knot is a rare but serious surgical emergency.
• Previous literature consists mainly of case reports and retrospective reviews.
• Limited personal experience often hinders understanding of this condition.

Purpose of the Study:

• To present the personal experience with ileosigmoid knot.
• To describe the largest reported prospective study on this rare condition.

Main Methods:

• A prospective study of seven patients treated for ileosigmoid knot over three years.
• Analysis of clinical, radiological, and sigmoidoscopic features for diagnosis.
• Evaluation of surgical outcomes including knot unraveling, resection, and anastomosis.

Main Results:

• Ileosigmoid knot predominantly affects males in their fourth decade.
• Mean symptom duration was 22 hours; preoperative diagnosis achieved in 71% of cases.
• Successful knot unraveling in 71%; sigmoid colon gangrene in 100%, ileum in 43%; primary anastomosis performed in all cases with no mortality.

Conclusions:

• Combined clinical, radiological, and sigmoidoscopic findings aid preoperative diagnosis of ileosigmoid knot.
• Knot unraveling is beneficial unless both bowel segments are gangrenous.
• Primary anastomosis following resection is a safe and preferred management strategy.